HOLY FAMILY HOSPITAL - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hopsital_Cdm_Chg , Self_Pay_Chg , Minimum_Negotiated_Chg , Maximum_Negotiated_Chg , AETNA , AETNA MEDICARE , AMISH COMMUNITY DISCOUNT , BC EXCHANGE , BC MEDICARE , BCBS OF ILLINOIS PPO , BLUE CROSS BLUE SHEILD OF ILLINOIS DUAL , BLUE CROSS BLUE SHIELD  IL HMO , BLUE CROSS BLUE SHIELD OF ILLINOIS MEDICARE ADV , CELTIC INSURANCE COMPANY , CIGNA , CLAIM DOC , CLEAR SPRING HEALTH MEDICARE ADV , COFINITY , CONSOCIATE GROUP ," ESSENCE, L.L.P. ", FIRST HEALTH NETWORK , HEALTH ALLIANCE MEDICAL PLAN EXCHANGE , HEALTHLINK , HEALTHLINK PPO , HOPETRUST , HUMANA , HUMANA MEDICARE , HUMANA MEDICARE ADVANTAGE , LIVE360 HSHS HEALTHY PLAN , LIVE360 MEDICARE COST PLAN , LIVE360 NON HSHS HEALTHY PLAN , MERIDIAN HMO MCD , MULTIPLAN , NAPHCARE , PLAIN CHURCH MEDICAL GROUP , PROVIDER NETWORK OF AMERICA , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , WELLFIRST 
HSHS HOLY FAMILY HOSPITAL INC (ACU),N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$39,336.51 ","$6,405.69 ","$82,802.05 ","$39,336.51 ","$81,146.01 ","$16,944.96 ","$35,800.95 ","$81,146.01 ","$40,682.85 ","$59,307.35 ","$32,641.65 ","$59,307.35 ","$59,307.35 ","$42,362.39 ","$60,517.70 ","$81,957.47 ","$51,440.05 ","$54,465.93 ","$81,146.01 ","$45,388.28 ","$33,284.74 ","$41,757.21 ","$41,757.21 ","$60,517.70 ","$21,000.00 ","$82,802.05 ","$82,802.05 ","$42,422.91 ","$81,146.01 ","$25,175.36 ","$6,405.69 ","$45,388.28 ","$60,517.70 ","$16,944.96 ","$54,465.93 ","$60,517.70 ","$59,307.35 ","$39,336.51 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$9,948.71 ","$2,623.91 ","$21,900.68 ","$9,948.71 ","$21,683.84 ","$4,285.60 ","$4,773.46 ","$21,683.84 ","$5,424.38 ","$15,305.70 ","$4,352.22 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$21,900.68 ","$13,009.85 ","$13,775.13 ","$21,683.84 ","$11,479.28 ","$8,418.14 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$2,800.00 ","$21,683.84 ","$21,683.84 ","$10,729.30 ","$21,683.84 ","$6,367.17 ","$2,623.91 ","$3,000.00 ","$15,305.70 ","$4,285.60 ","$13,775.13 ","$15,305.70 ","$15,305.70 ","$9,948.71 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$7,445.85 ","$2,623.91 ","$16,644.00 ","$7,445.85 ","$16,479.21 ","$3,207.44 ","$4,773.46 ","$16,479.21 ","$5,424.38 ","$11,455.16 ","$4,352.22 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$16,644.00 ","$9,736.89 ","$10,309.64 ","$16,479.21 ","$8,591.37 ","$6,300.34 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$2,800.00 ","$16,479.21 ","$16,479.21 ","$8,030.07 ","$16,479.21 ","$4,765.35 ","$2,623.91 ","$3,000.00 ","$11,455.16 ","$3,207.44 ","$10,309.64 ","$11,455.16 ","$11,455.16 ","$7,445.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$15,401.47 ","$2,623.91 ","$33,024.48 ","$15,401.47 ","$32,363.99 ","$6,634.48 ","$7,160.19 ","$32,363.99 ","$8,136.57 ","$23,220.68 ","$6,528.33 ","$23,220.68 ","$23,220.68 ","$16,586.20 ","$23,694.57 ","$32,687.63 ","$20,140.38 ","$21,325.11 ","$32,363.99 ","$17,770.93 ","$13,032.01 ","$23,694.57 ","$23,694.57 ","$23,694.57 ","$4,200.00 ","$33,024.48 ","$33,024.48 ","$16,609.89 ","$32,363.99 ","$9,856.94 ","$2,623.91 ","$4,500.00 ","$23,694.57 ","$6,634.48 ","$21,325.11 ","$23,694.57 ","$23,220.68 ","$15,401.47 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$4,438.60 ","$1,912.01 ","$10,327.29 ","$4,438.60 ","$10,225.04 ","$1,912.01 ","$4,773.46 ","$10,225.04 ","$5,424.38 ","$6,828.61 ","$4,352.22 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$10,327.29 ","$5,804.32 ","$6,145.75 ","$10,225.04 ","$5,121.46 ","$3,755.74 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$2,800.00 ","$10,225.04 ","$10,225.04 ","$4,786.86 ","$10,225.04 ","$2,840.70 ","$2,623.91 ","$3,000.00 ","$6,828.61 ","$1,912.01 ","$6,145.75 ","$6,828.61 ","$6,828.61 ","$4,438.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),12000001,N/A,HC DAILY SERVICE GENERAL,120,1 ,$917.40 ,$596.31 ,$256.87 ,$917.40 ,$596.31 , Inpatient Medicare ,$256.87 ,"$2,257.71 ", Inpatient Medicare ,"$2,565.58 ", Inpatient Medicare ,"$2,176.11 ", Inpatient Medicare , Inpatient Medicare +90% ,"$7,800.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% ,$779.79 ,$825.66 , Inpatient Medicare ,$688.05 ,$504.57 ,"$9,287.00 ","$9,287.00 ", Inpatient Medicare +150% ,"$1,400.00 ", Inpatient Medicare , Inpatient Medicare ,$643.10 , Inpatient Medicare ,$381.64 , Inpatient Medicaid +10% ,$779.79 , Inpatient Medicare +80% ,$256.87 ,$825.66 ,"$8,150.00 ", Inpatient Medicare ,$596.31 
HSHS HOLY FAMILY HOSPITAL INC (ACU),12000002,N/A,HC DAILY SERVICE SWING BED,120,1 ,$526.90 ,$342.49 ,$147.53 ,$526.90 ,$342.49 , Inpatient Medicare ,$147.53 ,"$2,257.71 ", Inpatient Medicare ,"$2,565.58 ", Inpatient Medicare ,"$2,176.11 ", Inpatient Medicare , Inpatient Medicare +90% ,"$7,800.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% ,$447.87 ,$474.21 , Inpatient Medicare ,$395.18 ,$289.79 ,"$9,287.00 ","$9,287.00 ", Inpatient Medicare +150% ,"$1,400.00 ", Inpatient Medicare , Inpatient Medicare ,$369.36 , Inpatient Medicare ,$219.19 , Inpatient Medicaid +10% ,$447.86 , Inpatient Medicare +80% ,$147.53 ,$474.21 ,"$8,150.00 ", Inpatient Medicare ,$342.49 
HSHS HOLY FAMILY HOSPITAL INC (ACU),12000006,N/A,HC DAILY SERVICE W/TELEMETRY,120,1 ,$917.40 ,$596.31 ,$256.87 ,$917.40 ,$596.31 , Inpatient Medicare ,$256.87 ,"$2,257.71 ", Inpatient Medicare ,"$2,565.58 ", Inpatient Medicare ,"$2,176.11 ", Inpatient Medicare , Inpatient Medicare +90% ,"$7,800.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% ,$779.79 ,$825.66 , Inpatient Medicare ,$688.05 ,$504.57 ,"$9,287.00 ","$9,287.00 ", Inpatient Medicare +150% ,"$1,400.00 ", Inpatient Medicare , Inpatient Medicare ,$643.10 , Inpatient Medicare ,$381.64 , Inpatient Medicaid +10% ,$779.79 , Inpatient Medicare +80% ,$256.87 ,$825.66 ,"$8,150.00 ", Inpatient Medicare ,$596.31 
HSHS HOLY FAMILY HOSPITAL INC (ACU),12500001,N/A,HC DAILY HOSPICE ACUTE CARE,125,1 ,$917.40 ,$596.31 ,$256.87 ,$917.40 ,$596.31 , Inpatient Medicare ,$256.87 ,"$2,257.71 ", Inpatient Medicare ,"$2,565.58 ", Inpatient Medicare ,"$2,176.11 ", Inpatient Medicare , Inpatient Medicare +90% ,"$7,800.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% ,$779.79 ,$825.66 , Inpatient Medicare ,$688.05 ,$504.57 ,"$9,287.00 ","$9,287.00 ", Inpatient Medicare +150% ,"$1,400.00 ", Inpatient Medicare , Inpatient Medicare ,$643.10 , Inpatient Medicare ,$381.64 , Inpatient Medicaid +10% ,$779.79 , Inpatient Medicare +80% ,$256.87 ,$825.66 ,"$1,138.00 ", Inpatient Medicare ,$596.31 
HSHS HOLY FAMILY HOSPITAL INC (ACU),25000225,N/A,HC SILVER NITRATE APPLICATOR STICK,250,1 ,$63.00 ,$40.95 ,$17.64 ,$63.00 ,$40.95 , N/A ,$17.64 ,$31.88 , N/A ,$36.23 , N/A ,$31.87 , N/A , N/A ,$51.66 , N/A , N/A ,$53.55 ,$56.70 , N/A ,$47.25 ,$44.10 ,$46.62 ,$46.62 , N/A ,$53.55 , N/A , N/A ,$44.16 , N/A ,$26.21 , N/A ,$53.55 , N/A ,$17.64 ,$56.70 ,$33.26 , N/A ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$387.00 ,$251.55 ,$108.36 ,$504.21 ,$251.55 ,$201.68 ,$108.36 ,$195.82 ,$201.68 ,$222.53 ,$201.68 ,$195.78 ,$201.68 ,$383.20 ,$317.34 ,$504.21 ,$201.68 ,$328.95 ,$348.30 ,$201.68 ,$290.25 ,$270.90 ,$286.38 ,$286.38 ,$387.00 ,$328.95 ,$201.68 ,$201.68 ,$271.29 ,$201.68 ,$160.99 , N/A ,$328.95 ,$433.62 ,$108.36 ,$348.30 ,$204.34 ,$201.68 ,$251.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$157.00 ,$102.05 ,$39.45 ,$157.00 ,$102.05 ,$39.45 ,$43.96 ,$79.44 ,$39.45 ,$90.28 ,$39.45 ,$79.43 ,$39.45 ,$74.96 ,$128.74 ,$98.63 ,$39.45 ,$133.45 ,$141.30 ,$39.45 ,$117.75 ,$109.90 ,$116.18 ,$116.18 ,$98.63 ,$133.45 ,$39.45 ,$39.45 ,$110.06 ,$39.45 ,$65.31 , N/A ,$133.45 ,$84.82 ,$43.96 ,$141.30 ,$82.90 ,$39.45 ,$102.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$351.00 ,$228.15 ,$98.28 ,$504.21 ,$228.15 ,$201.68 ,$98.28 ,$177.61 ,$201.68 ,$201.83 ,$201.68 ,$177.57 ,$201.68 ,$351.00 ,$287.82 ,$504.21 ,$201.68 ,$298.35 ,$315.90 ,$201.68 ,$263.25 ,$245.70 ,$259.74 ,$259.74 ,$351.00 ,$298.35 ,$201.68 ,$201.68 ,$246.05 ,$201.68 ,$146.02 , N/A ,$298.35 ,$433.62 ,$98.28 ,$315.90 ,$185.33 ,$201.68 ,$228.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$152.00 ,$98.80 ,$39.45 ,$152.00 ,$98.80 ,$39.45 ,$42.56 ,$76.91 ,$39.45 ,$87.40 ,$39.45 ,$76.90 ,$39.45 ,$74.96 ,$124.64 ,$98.63 ,$39.45 ,$129.20 ,$136.80 ,$39.45 ,$114.00 ,$106.40 ,$112.48 ,$112.48 ,$98.63 ,$129.20 ,$39.45 ,$39.45 ,$106.55 ,$39.45 ,$63.23 , N/A ,$129.20 ,$84.82 ,$42.56 ,$136.80 ,$80.26 ,$39.45 ,$98.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$192.00 ,$124.80 ,$53.76 ,$192.00 ,$124.80 ,$61.12 ,$53.76 ,$97.15 ,$61.12 ,$110.40 ,$61.12 ,$97.13 ,$61.12 ,$116.14 ,$157.44 ,$152.81 ,$61.12 ,$163.20 ,$172.80 ,$61.12 ,$144.00 ,$134.40 ,$142.08 ,$142.08 ,$152.81 ,$163.20 ,$61.12 ,$61.12 ,$134.59 ,$61.12 ,$79.87 , N/A ,$163.20 ,$131.42 ,$53.76 ,$172.80 ,$101.38 ,$61.12 ,$124.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),26000005,96368,HC INFUS CONCURRENT,260,1 ,$192.00 ,$124.80 ,$53.76 ,$192.00 ,$124.80 , N/A ,$53.76 ,$97.15 , N/A ,$110.40 , N/A ,$97.13 , N/A , N/A ,$157.44 , N/A , N/A ,$163.20 ,$172.80 , N/A ,$144.00 ,$134.40 ,$142.08 ,$142.08 , N/A ,$163.20 , N/A , N/A ,$134.59 , N/A ,$79.87 , N/A ,$163.20 , N/A ,$53.76 ,$172.80 ,$101.38 , N/A ,$124.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000011,N/A,HC PACK HOT/COLD,270,1 ,$48.00 ,$31.20 ,$13.44 ,$48.00 ,$31.20 , N/A ,$13.44 ,$24.29 , N/A ,$27.60 , N/A ,$24.28 , N/A , N/A ,$39.36 , N/A , N/A ,$40.80 ,$43.20 , N/A ,$36.00 ,$33.60 ,$35.52 ,$35.52 , N/A ,$40.80 , N/A , N/A ,$33.65 , N/A ,$19.97 , N/A ,$40.80 , N/A ,$13.44 ,$43.20 ,$25.34 , N/A ,$31.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000015,N/A,HC SET IV EXTENSION,270,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 ,$5.85 , N/A ,$2.52 ,$4.55 , N/A ,$5.18 , N/A ,$4.55 , N/A , N/A ,$7.38 , N/A , N/A ,$7.65 ,$8.10 , N/A ,$6.75 ,$6.30 ,$6.66 ,$6.66 , N/A ,$7.65 , N/A , N/A ,$6.31 , N/A ,$3.74 , N/A ,$7.65 , N/A ,$2.52 ,$8.10 ,$4.75 , N/A ,$5.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000022,N/A,HC TRAY BIOPSY,270,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 ,$20.80 , N/A ,$8.96 ,$16.19 , N/A ,$18.40 , N/A ,$16.19 , N/A , N/A ,$26.24 , N/A , N/A ,$27.20 ,$28.80 , N/A ,$24.00 ,$22.40 ,$23.68 ,$23.68 , N/A ,$27.20 , N/A , N/A ,$22.43 , N/A ,$13.31 , N/A ,$27.20 , N/A ,$8.96 ,$28.80 ,$16.90 , N/A ,$20.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000028,N/A,HC ELECTRODE TIER 1,270,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 ,$11.70 , N/A ,$5.04 ,$9.11 , N/A ,$10.35 , N/A ,$9.11 , N/A , N/A ,$14.76 , N/A , N/A ,$15.30 ,$16.20 , N/A ,$13.50 ,$12.60 ,$13.32 ,$13.32 , N/A ,$15.30 , N/A , N/A ,$12.62 , N/A ,$7.49 , N/A ,$15.30 , N/A ,$5.04 ,$16.20 ,$9.50 , N/A ,$11.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000033,N/A,HC ELECTRODE TIER 3,270,1 ,$77.00 ,$50.05 ,$21.56 ,$77.00 ,$50.05 , N/A ,$21.56 ,$38.96 , N/A ,$44.28 , N/A ,$38.95 , N/A , N/A ,$63.14 , N/A , N/A ,$65.45 ,$69.30 , N/A ,$57.75 ,$53.90 ,$56.98 ,$56.98 , N/A ,$65.45 , N/A , N/A ,$53.98 , N/A ,$32.03 , N/A ,$65.45 , N/A ,$21.56 ,$69.30 ,$40.66 , N/A ,$50.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000054,N/A,HC KIT BLOOD GLUCOSE,270,1 ,$23.00 ,$14.95 ,$6.44 ,$23.00 ,$14.95 , N/A ,$6.44 ,$11.64 , N/A ,$13.23 , N/A ,$11.64 , N/A , N/A ,$18.86 , N/A , N/A ,$19.55 ,$20.70 , N/A ,$17.25 ,$16.10 ,$17.02 ,$17.02 , N/A ,$19.55 , N/A , N/A ,$16.12 , N/A ,$9.57 , N/A ,$19.55 , N/A ,$6.44 ,$20.70 ,$12.14 , N/A ,$14.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000129,N/A,HC STERILIZATION WRAP,270,1 ,$385.00 ,$250.25 ,$107.80 ,$385.00 ,$250.25 , N/A ,$107.80 ,$194.81 , N/A ,$221.38 , N/A ,$194.77 , N/A , N/A ,$315.70 , N/A , N/A ,$327.25 ,$346.50 , N/A ,$288.75 ,$269.50 ,$284.90 ,$284.90 , N/A ,$327.25 , N/A , N/A ,$269.89 , N/A ,$160.16 , N/A ,$327.25 , N/A ,$107.80 ,$346.50 ,$203.28 , N/A ,$250.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000134,N/A,HC ADAPTER AIRWAY CAP,270,1 ,$23.00 ,$14.95 ,$6.44 ,$23.00 ,$14.95 , N/A ,$6.44 ,$11.64 , N/A ,$13.23 , N/A ,$11.64 , N/A , N/A ,$18.86 , N/A , N/A ,$19.55 ,$20.70 , N/A ,$17.25 ,$16.10 ,$17.02 ,$17.02 , N/A ,$19.55 , N/A , N/A ,$16.12 , N/A ,$9.57 , N/A ,$19.55 , N/A ,$6.44 ,$20.70 ,$12.14 , N/A ,$14.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000136,N/A,HC BIOTESTCELL,270,1 ,$142.00 ,$92.30 ,$39.76 ,$142.00 ,$92.30 , N/A ,$39.76 ,$71.85 , N/A ,$81.65 , N/A ,$71.84 , N/A , N/A ,$116.44 , N/A , N/A ,$120.70 ,$127.80 , N/A ,$106.50 ,$99.40 ,$105.08 ,$105.08 , N/A ,$120.70 , N/A , N/A ,$99.54 , N/A ,$59.07 , N/A ,$120.70 , N/A ,$39.76 ,$127.80 ,$74.98 , N/A ,$92.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000138,N/A,HC NANOSCOPE HANDPIECE,270,1 ,$24.00 ,$15.60 ,$6.72 ,$24.00 ,$15.60 , N/A ,$6.72 ,$12.14 , N/A ,$13.80 , N/A ,$12.14 , N/A , N/A ,$19.68 , N/A , N/A ,$20.40 ,$21.60 , N/A ,$18.00 ,$16.80 ,$17.76 ,$17.76 , N/A ,$20.40 , N/A , N/A ,$16.82 , N/A ,$9.98 , N/A ,$20.40 , N/A ,$6.72 ,$21.60 ,$12.67 , N/A ,$15.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27000141,N/A,HC QUANTIFY PLUS CONTROL BILEVEL,270,1 ,$126.00 ,$81.90 ,$35.28 ,$126.00 ,$81.90 , N/A ,$35.28 ,$63.76 , N/A ,$72.45 , N/A ,$63.74 , N/A , N/A ,$103.32 , N/A , N/A ,$107.10 ,$113.40 , N/A ,$94.50 ,$88.20 ,$93.24 ,$93.24 , N/A ,$107.10 , N/A , N/A ,$88.33 , N/A ,$52.42 , N/A ,$107.10 , N/A ,$35.28 ,$113.40 ,$66.53 , N/A ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100013,N/A,HC BOOT HEEL LIFT,271,1 ,$61.00 ,$39.65 ,$17.08 ,$61.00 ,$39.65 , N/A ,$17.08 ,$30.87 , N/A ,$35.08 , N/A ,$30.86 , N/A , N/A ,$50.02 , N/A , N/A ,$51.85 ,$54.90 , N/A ,$45.75 ,$42.70 ,$45.14 ,$45.14 , N/A ,$51.85 , N/A , N/A ,$42.76 , N/A ,$25.38 , N/A ,$51.85 , N/A ,$17.08 ,$54.90 ,$32.21 , N/A ,$39.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100038,N/A,HC CPAP MASK,271,1 ,$51.00 ,$33.15 ,$14.28 ,$51.00 ,$33.15 , N/A ,$14.28 ,$25.81 , N/A ,$29.33 , N/A ,$25.80 , N/A , N/A ,$41.82 , N/A , N/A ,$43.35 ,$45.90 , N/A ,$38.25 ,$35.70 ,$37.74 ,$37.74 , N/A ,$43.35 , N/A , N/A ,$35.75 , N/A ,$21.22 , N/A ,$43.35 , N/A ,$14.28 ,$45.90 ,$26.93 , N/A ,$33.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100080,N/A,HC LARYNGEAL MASK AIRWAY,272,1 ,$16.00 ,$10.40 ,$4.48 ,$16.00 ,$10.40 , N/A ,$4.48 ,$8.10 , N/A ,$9.20 , N/A ,$8.09 , N/A , N/A ,$13.12 , N/A , N/A ,$13.60 ,$14.40 , N/A ,$12.00 ,$11.20 ,$11.84 ,$11.84 , N/A ,$13.60 , N/A , N/A ,$11.22 , N/A ,$6.66 , N/A ,$13.60 , N/A ,$4.48 ,$14.40 ,$8.45 , N/A ,$10.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100096,N/A,HC NASAL PHANYNGEAL AIRWAY,271,1 ,$19.00 ,$12.35 ,$5.32 ,$19.00 ,$12.35 , N/A ,$5.32 ,$9.61 , N/A ,$10.93 , N/A ,$9.61 , N/A , N/A ,$15.58 , N/A , N/A ,$16.15 ,$17.10 , N/A ,$14.25 ,$13.30 ,$14.06 ,$14.06 , N/A ,$16.15 , N/A , N/A ,$13.32 , N/A ,$7.90 , N/A ,$16.15 , N/A ,$5.32 ,$17.10 ,$10.03 , N/A ,$12.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100125,N/A,HC SHOULDER PULLEY METAL,271,1 ,$66.00 ,$42.90 ,$18.48 ,$66.00 ,$42.90 , N/A ,$18.48 ,$33.40 , N/A ,$37.95 , N/A ,$33.39 , N/A , N/A ,$54.12 , N/A , N/A ,$56.10 ,$59.40 , N/A ,$49.50 ,$46.20 ,$48.84 ,$48.84 , N/A ,$56.10 , N/A , N/A ,$46.27 , N/A ,$27.46 , N/A ,$56.10 , N/A ,$18.48 ,$59.40 ,$34.85 , N/A ,$42.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100155,N/A,HC THERABAND PER FOOT,271,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 ,$3.25 , N/A ,$1.40 ,$2.53 , N/A ,$2.88 , N/A ,$2.53 , N/A , N/A ,$4.10 , N/A , N/A ,$4.25 ,$4.50 , N/A ,$3.75 ,$3.50 ,$3.70 ,$3.70 , N/A ,$4.25 , N/A , N/A ,$3.51 , N/A ,$2.08 , N/A ,$4.25 , N/A ,$1.40 ,$4.50 ,$2.64 , N/A ,$3.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100182,N/A,HC HAND SPLINT,271,1 ,$81.00 ,$52.65 ,$22.68 ,$81.00 ,$52.65 , N/A ,$22.68 ,$40.99 , N/A ,$46.58 , N/A ,$40.98 , N/A , N/A ,$66.42 , N/A , N/A ,$68.85 ,$72.90 , N/A ,$60.75 ,$56.70 ,$59.94 ,$59.94 , N/A ,$68.85 , N/A , N/A ,$56.78 , N/A ,$33.70 , N/A ,$68.85 , N/A ,$22.68 ,$72.90 ,$42.77 , N/A ,$52.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100204,N/A,HC CIRCUIT BREATHING,271,1 ,$31.00 ,$20.15 ,$8.68 ,$31.00 ,$20.15 , N/A ,$8.68 ,$15.69 , N/A ,$17.83 , N/A ,$15.68 , N/A , N/A ,$25.42 , N/A , N/A ,$26.35 ,$27.90 , N/A ,$23.25 ,$21.70 ,$22.94 ,$22.94 , N/A ,$26.35 , N/A , N/A ,$21.73 , N/A ,$12.90 , N/A ,$26.35 , N/A ,$8.68 ,$27.90 ,$16.37 , N/A ,$20.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100234,N/A,HC MASK BIPAP,271,1 ,$63.00 ,$40.95 ,$17.64 ,$63.00 ,$40.95 , N/A ,$17.64 ,$31.88 , N/A ,$36.23 , N/A ,$31.87 , N/A , N/A ,$51.66 , N/A , N/A ,$53.55 ,$56.70 , N/A ,$47.25 ,$44.10 ,$46.62 ,$46.62 , N/A ,$53.55 , N/A , N/A ,$44.16 , N/A ,$26.21 , N/A ,$53.55 , N/A ,$17.64 ,$56.70 ,$33.26 , N/A ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100254,N/A,HC CUFF BLOOD PRESSURE,271,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 ,$17.55 , N/A ,$7.56 ,$13.66 , N/A ,$15.53 , N/A ,$13.66 , N/A , N/A ,$22.14 , N/A , N/A ,$22.95 ,$24.30 , N/A ,$20.25 ,$18.90 ,$19.98 ,$19.98 , N/A ,$22.95 , N/A , N/A ,$18.93 , N/A ,$11.23 , N/A ,$22.95 , N/A ,$7.56 ,$24.30 ,$14.26 , N/A ,$17.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100263,N/A,HC POSITIONER HEAD,271,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 ,$17.55 , N/A ,$7.56 ,$13.66 , N/A ,$15.53 , N/A ,$13.66 , N/A , N/A ,$22.14 , N/A , N/A ,$22.95 ,$24.30 , N/A ,$20.25 ,$18.90 ,$19.98 ,$19.98 , N/A ,$22.95 , N/A , N/A ,$18.93 , N/A ,$11.23 , N/A ,$22.95 , N/A ,$7.56 ,$24.30 ,$14.26 , N/A ,$17.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100320,N/A,HC KIT MEDICAL SUPPLY TRANSPORT,271,1 ,$430.00 ,$279.50 ,$120.40 ,$430.00 ,$279.50 , N/A ,$120.40 ,$217.58 , N/A ,$247.25 , N/A ,$217.54 , N/A , N/A ,$352.60 , N/A , N/A ,$365.50 ,$387.00 , N/A ,$322.50 ,$301.00 ,$318.20 ,$318.20 , N/A ,$365.50 , N/A , N/A ,$301.43 , N/A ,$178.88 , N/A ,$365.50 , N/A ,$120.40 ,$387.00 ,$227.04 , N/A ,$279.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27100489,N/A,HC MASK RESPIRATOR,271,1 ,$90.00 ,$58.50 ,$25.20 ,$90.00 ,$58.50 , N/A ,$25.20 ,$45.54 , N/A ,$51.75 , N/A ,$45.53 , N/A , N/A ,$73.80 , N/A , N/A ,$76.50 ,$81.00 , N/A ,$67.50 ,$63.00 ,$66.60 ,$66.60 , N/A ,$76.50 , N/A , N/A ,$63.09 , N/A ,$37.44 , N/A ,$76.50 , N/A ,$25.20 ,$81.00 ,$47.52 , N/A ,$58.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27200054,C1751,HC KIT CATHETER,272,1 ,$152.00 ,$98.80 ,$42.56 ,$152.00 ,$98.80 , N/A ,$42.56 ,$76.91 , N/A ,$87.40 , N/A ,$76.90 , N/A , N/A ,$124.64 , N/A , N/A ,$129.20 ,$136.80 , N/A ,$114.00 ,$106.40 ,$112.48 ,$112.48 , N/A ,$129.20 , N/A , N/A ,$106.55 , N/A ,$63.23 , N/A ,$129.20 , N/A ,$42.56 ,$136.80 ,$80.26 , N/A ,$98.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27200288,N/A,HC BAG AMBU,272,1 ,$82.00 ,$53.30 ,$22.96 ,$82.00 ,$53.30 , N/A ,$22.96 ,$41.49 , N/A ,$47.15 , N/A ,$41.48 , N/A , N/A ,$67.24 , N/A , N/A ,$69.70 ,$73.80 , N/A ,$61.50 ,$57.40 ,$60.68 ,$60.68 , N/A ,$69.70 , N/A , N/A ,$57.48 , N/A ,$34.11 , N/A ,$69.70 , N/A ,$22.96 ,$73.80 ,$43.30 , N/A ,$53.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27200357,N/A,HC BIS MONITOR STRIP,272,1 ,$46.00 ,$29.90 ,$12.88 ,$46.00 ,$29.90 , N/A ,$12.88 ,$23.28 , N/A ,$26.45 , N/A ,$23.27 , N/A , N/A ,$37.72 , N/A , N/A ,$39.10 ,$41.40 , N/A ,$34.50 ,$32.20 ,$34.04 ,$34.04 , N/A ,$39.10 , N/A , N/A ,$32.25 , N/A ,$19.14 , N/A ,$39.10 , N/A ,$12.88 ,$41.40 ,$24.29 , N/A ,$29.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27200543,N/A,HC BLOOD FILTER,272,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 ,$23.40 , N/A ,$10.08 ,$18.22 , N/A ,$20.70 , N/A ,$18.21 , N/A , N/A ,$29.52 , N/A , N/A ,$30.60 ,$32.40 , N/A ,$27.00 ,$25.20 ,$26.64 ,$26.64 , N/A ,$30.60 , N/A , N/A ,$25.24 , N/A ,$14.98 , N/A ,$30.60 , N/A ,$10.08 ,$32.40 ,$19.01 , N/A ,$23.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27201165,N/A,HC MORGAN LENS,272,1 ,$96.00 ,$62.40 ,$26.88 ,$96.00 ,$62.40 , N/A ,$26.88 ,$48.58 , N/A ,$55.20 , N/A ,$48.57 , N/A , N/A ,$78.72 , N/A , N/A ,$81.60 ,$86.40 , N/A ,$72.00 ,$67.20 ,$71.04 ,$71.04 , N/A ,$81.60 , N/A , N/A ,$67.30 , N/A ,$39.94 , N/A ,$81.60 , N/A ,$26.88 ,$86.40 ,$50.69 , N/A ,$62.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27201250,N/A,HC EPIDURAL TRAY SNGL USE,272,1 ,$111.00 ,$72.15 ,$31.08 ,$111.00 ,$72.15 , N/A ,$31.08 ,$56.17 , N/A ,$63.83 , N/A ,$56.15 , N/A , N/A ,$91.02 , N/A , N/A ,$94.35 ,$99.90 , N/A ,$83.25 ,$77.70 ,$82.14 ,$82.14 , N/A ,$94.35 , N/A , N/A ,$77.81 , N/A ,$46.18 , N/A ,$94.35 , N/A ,$31.08 ,$99.90 ,$58.61 , N/A ,$72.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27201251,N/A,HC EPIDURAL/SPINAL TRAY,272,1 ,$107.00 ,$69.55 ,$29.96 ,$107.00 ,$69.55 , N/A ,$29.96 ,$54.14 , N/A ,$61.53 , N/A ,$54.13 , N/A , N/A ,$87.74 , N/A , N/A ,$90.95 ,$96.30 , N/A ,$80.25 ,$74.90 ,$79.18 ,$79.18 , N/A ,$90.95 , N/A , N/A ,$75.01 , N/A ,$44.51 , N/A ,$90.95 , N/A ,$29.96 ,$96.30 ,$56.50 , N/A ,$69.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27201832,N/A,HC PEP DEVICE,272,1 ,$90.00 ,$58.50 ,$25.20 ,$90.00 ,$58.50 , N/A ,$25.20 ,$45.54 , N/A ,$51.75 , N/A ,$45.53 , N/A , N/A ,$73.80 , N/A , N/A ,$76.50 ,$81.00 , N/A ,$67.50 ,$63.00 ,$66.60 ,$66.60 , N/A ,$76.50 , N/A , N/A ,$63.09 , N/A ,$37.44 , N/A ,$76.50 , N/A ,$25.20 ,$81.00 ,$47.52 , N/A ,$58.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27202743,N/A,HC TRAY CATH,272,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 ,$13.65 , N/A ,$5.88 ,$10.63 , N/A ,$12.08 , N/A ,$10.62 , N/A , N/A ,$17.22 , N/A , N/A ,$17.85 ,$18.90 , N/A ,$15.75 ,$14.70 ,$15.54 ,$15.54 , N/A ,$17.85 , N/A , N/A ,$14.72 , N/A ,$8.74 , N/A ,$17.85 , N/A ,$5.88 ,$18.90 ,$11.09 , N/A ,$13.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27202759,N/A,HC TRAY EPIDURAL CONTINUOUS,272,1 ,$111.00 ,$72.15 ,$31.08 ,$111.00 ,$72.15 , N/A ,$31.08 ,$56.17 , N/A ,$63.83 , N/A ,$56.15 , N/A , N/A ,$91.02 , N/A , N/A ,$94.35 ,$99.90 , N/A ,$83.25 ,$77.70 ,$82.14 ,$82.14 , N/A ,$94.35 , N/A , N/A ,$77.81 , N/A ,$46.18 , N/A ,$94.35 , N/A ,$31.08 ,$99.90 ,$58.61 , N/A ,$72.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27202807,N/A,HC TRAY SPINAL,272,1 ,$83.00 ,$53.95 ,$23.24 ,$83.00 ,$53.95 , N/A ,$23.24 ,$42.00 , N/A ,$47.73 , N/A ,$41.99 , N/A , N/A ,$68.06 , N/A , N/A ,$70.55 ,$74.70 , N/A ,$62.25 ,$58.10 ,$61.42 ,$61.42 , N/A ,$70.55 , N/A , N/A ,$58.18 , N/A ,$34.53 , N/A ,$70.55 , N/A ,$23.24 ,$74.70 ,$43.82 , N/A ,$53.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203106,N/A,HC BIOPSY FORCEPS DISP,272,1 ,$26.00 ,$16.90 ,$7.28 ,$26.00 ,$16.90 , N/A ,$7.28 ,$13.16 , N/A ,$14.95 , N/A ,$13.15 , N/A , N/A ,$21.32 , N/A , N/A ,$22.10 ,$23.40 , N/A ,$19.50 ,$18.20 ,$19.24 ,$19.24 , N/A ,$22.10 , N/A , N/A ,$18.23 , N/A ,$10.82 , N/A ,$22.10 , N/A ,$7.28 ,$23.40 ,$13.73 , N/A ,$16.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203255,N/A,HC CPM PADS,272,1 ,$66.00 ,$42.90 ,$18.48 ,$66.00 ,$42.90 , N/A ,$18.48 ,$33.40 , N/A ,$37.95 , N/A ,$33.39 , N/A , N/A ,$54.12 , N/A , N/A ,$56.10 ,$59.40 , N/A ,$49.50 ,$46.20 ,$48.84 ,$48.84 , N/A ,$56.10 , N/A , N/A ,$46.27 , N/A ,$27.46 , N/A ,$56.10 , N/A ,$18.48 ,$59.40 ,$34.85 , N/A ,$42.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203531,C1751,HC CATHETER CV TRIPLE-LUMEN,272,1 ,$314.00 ,$204.10 ,$87.92 ,$314.00 ,$204.10 , N/A ,$87.92 ,$158.88 , N/A ,$180.55 , N/A ,$158.85 , N/A , N/A ,$257.48 , N/A , N/A ,$266.90 ,$282.60 , N/A ,$235.50 ,$219.80 ,$232.36 ,$232.36 , N/A ,$266.90 , N/A , N/A ,$220.11 , N/A ,$130.62 , N/A ,$266.90 , N/A ,$87.92 ,$282.60 ,$165.79 , N/A ,$204.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203537,N/A,HC CATHETER RADIAL ARTERY,272,1 ,$13.00 ,$8.45 ,$3.64 ,$13.00 ,$8.45 , N/A ,$3.64 ,$6.58 , N/A ,$7.48 , N/A ,$6.58 , N/A , N/A ,$10.66 , N/A , N/A ,$11.05 ,$11.70 , N/A ,$9.75 ,$9.10 ,$9.62 ,$9.62 , N/A ,$11.05 , N/A , N/A ,$9.11 , N/A ,$5.41 , N/A ,$11.05 , N/A ,$3.64 ,$11.70 ,$6.86 , N/A ,$8.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203580,N/A,HC KIT IV START,272,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 ,$9.75 , N/A ,$4.20 ,$7.59 , N/A ,$8.63 , N/A ,$7.59 , N/A , N/A ,$12.30 , N/A , N/A ,$12.75 ,$13.50 , N/A ,$11.25 ,$10.50 ,$11.10 ,$11.10 , N/A ,$12.75 , N/A , N/A ,$10.52 , N/A ,$6.24 , N/A ,$12.75 , N/A ,$4.20 ,$13.50 ,$7.92 , N/A ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203607,N/A,HC CIRCUIT CPAP/BIPAP,272,1 ,$16.00 ,$10.40 ,$4.48 ,$16.00 ,$10.40 , N/A ,$4.48 ,$8.10 , N/A ,$9.20 , N/A ,$8.09 , N/A , N/A ,$13.12 , N/A , N/A ,$13.60 ,$14.40 , N/A ,$12.00 ,$11.20 ,$11.84 ,$11.84 , N/A ,$13.60 , N/A , N/A ,$11.22 , N/A ,$6.66 , N/A ,$13.60 , N/A ,$4.48 ,$14.40 ,$8.45 , N/A ,$10.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27203844,N/A,HC TRAY CHEST TUBE,272,1 ,$122.00 ,$79.30 ,$34.16 ,$122.00 ,$79.30 , N/A ,$34.16 ,$61.73 , N/A ,$70.15 , N/A ,$61.72 , N/A , N/A ,$100.04 , N/A , N/A ,$103.70 ,$109.80 , N/A ,$91.50 ,$85.40 ,$90.28 ,$90.28 , N/A ,$103.70 , N/A , N/A ,$85.52 , N/A ,$50.75 , N/A ,$103.70 , N/A ,$34.16 ,$109.80 ,$64.42 , N/A ,$79.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204668,N/A,HC COLLAR CERVICAL ADJ ADULT,272,1 ,$34.00 ,$22.10 ,$9.52 ,$34.00 ,$22.10 , N/A ,$9.52 ,$17.20 , N/A ,$19.55 , N/A ,$17.20 , N/A , N/A ,$27.88 , N/A , N/A ,$28.90 ,$30.60 , N/A ,$25.50 ,$23.80 ,$25.16 ,$25.16 , N/A ,$28.90 , N/A , N/A ,$23.83 , N/A ,$14.14 , N/A ,$28.90 , N/A ,$9.52 ,$30.60 ,$17.95 , N/A ,$22.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204755,N/A,HC DEVICE BREAST BIOPSY,272,1 ,"$2,100.00 ","$1,365.00 ",$588.00 ,"$2,100.00 ","$1,365.00 ", N/A ,$588.00 ,"$1,062.60 ", N/A ,"$1,207.50 ", N/A ,"$1,062.39 ", N/A , N/A ,"$1,722.00 ", N/A , N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,575.00 ","$1,470.00 ","$1,554.00 ","$1,554.00 ", N/A ,"$1,785.00 ", N/A , N/A ,"$1,472.10 ", N/A ,$873.60 , N/A ,"$1,785.00 ", N/A ,$588.00 ,"$1,890.00 ","$1,108.80 ", N/A ,"$1,365.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204760,N/A,HC BLANKET BAIR HUGGER,272,1 ,$54.00 ,$35.10 ,$15.12 ,$54.00 ,$35.10 , N/A ,$15.12 ,$27.32 , N/A ,$31.05 , N/A ,$27.32 , N/A , N/A ,$44.28 , N/A , N/A ,$45.90 ,$48.60 , N/A ,$40.50 ,$37.80 ,$39.96 ,$39.96 , N/A ,$45.90 , N/A , N/A ,$37.85 , N/A ,$22.46 , N/A ,$45.90 , N/A ,$15.12 ,$48.60 ,$28.51 , N/A ,$35.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204859,N/A,HC HEMOSTAT SURGICAL,272,1 ,$165.00 ,$107.25 ,$46.20 ,$165.00 ,$107.25 , N/A ,$46.20 ,$83.49 , N/A ,$94.88 , N/A ,$83.47 , N/A , N/A ,$135.30 , N/A , N/A ,$140.25 ,$148.50 , N/A ,$123.75 ,$115.50 ,$122.10 ,$122.10 , N/A ,$140.25 , N/A , N/A ,$115.67 , N/A ,$68.64 , N/A ,$140.25 , N/A ,$46.20 ,$148.50 ,$87.12 , N/A ,$107.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204923,N/A,HC LIFT SLING LARGE/X-LARGE,272,1 ,$80.00 ,$52.00 ,$22.40 ,$80.00 ,$52.00 , N/A ,$22.40 ,$40.48 , N/A ,$46.00 , N/A ,$40.47 , N/A , N/A ,$65.60 , N/A , N/A ,$68.00 ,$72.00 , N/A ,$60.00 ,$56.00 ,$59.20 ,$59.20 , N/A ,$68.00 , N/A , N/A ,$56.08 , N/A ,$33.28 , N/A ,$68.00 , N/A ,$22.40 ,$72.00 ,$42.24 , N/A ,$52.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204944,N/A,HC NEEDLE SPINAL WHITACRE,272,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 ,$13.65 , N/A ,$5.88 ,$10.63 , N/A ,$12.08 , N/A ,$10.62 , N/A , N/A ,$17.22 , N/A , N/A ,$17.85 ,$18.90 , N/A ,$15.75 ,$14.70 ,$15.54 ,$15.54 , N/A ,$17.85 , N/A , N/A ,$14.72 , N/A ,$8.74 , N/A ,$17.85 , N/A ,$5.88 ,$18.90 ,$11.09 , N/A ,$13.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204988,N/A,HC BAG INFUSION PRESSURE,272,1 ,$66.00 ,$42.90 ,$18.48 ,$66.00 ,$42.90 , N/A ,$18.48 ,$33.40 , N/A ,$37.95 , N/A ,$33.39 , N/A , N/A ,$54.12 , N/A , N/A ,$56.10 ,$59.40 , N/A ,$49.50 ,$46.20 ,$48.84 ,$48.84 , N/A ,$56.10 , N/A , N/A ,$46.27 , N/A ,$27.46 , N/A ,$56.10 , N/A ,$18.48 ,$59.40 ,$34.85 , N/A ,$42.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204992,N/A,HC PROBE ESOPHAGEAL TEMP SENSOR,272,1 ,$17.00 ,$11.05 ,$4.76 ,$17.00 ,$11.05 , N/A ,$4.76 ,$8.60 , N/A ,$9.78 , N/A ,$8.60 , N/A , N/A ,$13.94 , N/A , N/A ,$14.45 ,$15.30 , N/A ,$12.75 ,$11.90 ,$12.58 ,$12.58 , N/A ,$14.45 , N/A , N/A ,$11.92 , N/A ,$7.07 , N/A ,$14.45 , N/A ,$4.76 ,$15.30 ,$8.98 , N/A ,$11.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27204999,N/A,HC SENSOR PULSE OX,272,1 ,$31.00 ,$20.15 ,$8.68 ,$31.00 ,$20.15 , N/A ,$8.68 ,$15.69 , N/A ,$17.83 , N/A ,$15.68 , N/A , N/A ,$25.42 , N/A , N/A ,$26.35 ,$27.90 , N/A ,$23.25 ,$21.70 ,$22.94 ,$22.94 , N/A ,$26.35 , N/A , N/A ,$21.73 , N/A ,$12.90 , N/A ,$26.35 , N/A ,$8.68 ,$27.90 ,$16.37 , N/A ,$20.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205074,N/A,HC TUBE TRACH,272,1 ,$62.00 ,$40.30 ,$17.36 ,$62.00 ,$40.30 , N/A ,$17.36 ,$31.37 , N/A ,$35.65 , N/A ,$31.37 , N/A , N/A ,$50.84 , N/A , N/A ,$52.70 ,$55.80 , N/A ,$46.50 ,$43.40 ,$45.88 ,$45.88 , N/A ,$52.70 , N/A , N/A ,$43.46 , N/A ,$25.79 , N/A ,$52.70 , N/A ,$17.36 ,$55.80 ,$32.74 , N/A ,$40.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205169,N/A,HC CUVETTE BLOOD CLOTTING,272,1 ,$754.00 ,$490.10 ,$211.12 ,$754.00 ,$490.10 , N/A ,$211.12 ,$381.52 , N/A ,$433.55 , N/A ,$381.45 , N/A , N/A ,$618.28 , N/A , N/A ,$640.90 ,$678.60 , N/A ,$565.50 ,$527.80 ,$557.96 ,$557.96 , N/A ,$640.90 , N/A , N/A ,$528.55 , N/A ,$313.66 , N/A ,$640.90 , N/A ,$211.12 ,$678.60 ,$398.11 , N/A ,$490.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205236,N/A,HC SYSTEM BIOPSY NEEDLE/INTRODUCER,272,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 ,$23.40 , N/A ,$10.08 ,$18.22 , N/A ,$20.70 , N/A ,$18.21 , N/A , N/A ,$29.52 , N/A , N/A ,$30.60 ,$32.40 , N/A ,$27.00 ,$25.20 ,$26.64 ,$26.64 , N/A ,$30.60 , N/A , N/A ,$25.24 , N/A ,$14.98 , N/A ,$30.60 , N/A ,$10.08 ,$32.40 ,$19.01 , N/A ,$23.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205269,N/A,HC CIRCUIT BREATHING W/EXPIRATORY VALVE,272,1 ,$57.00 ,$37.05 ,$15.96 ,$57.00 ,$37.05 , N/A ,$15.96 ,$28.84 , N/A ,$32.78 , N/A ,$28.84 , N/A , N/A ,$46.74 , N/A , N/A ,$48.45 ,$51.30 , N/A ,$42.75 ,$39.90 ,$42.18 ,$42.18 , N/A ,$48.45 , N/A , N/A ,$39.96 , N/A ,$23.71 , N/A ,$48.45 , N/A ,$15.96 ,$51.30 ,$30.10 , N/A ,$37.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205326,N/A,HC SENSOR INFANT ADHESIVE,272,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 ,$20.80 , N/A ,$8.96 ,$16.19 , N/A ,$18.40 , N/A ,$16.19 , N/A , N/A ,$26.24 , N/A , N/A ,$27.20 ,$28.80 , N/A ,$24.00 ,$22.40 ,$23.68 ,$23.68 , N/A ,$27.20 , N/A , N/A ,$22.43 , N/A ,$13.31 , N/A ,$27.20 , N/A ,$8.96 ,$28.80 ,$16.90 , N/A ,$20.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205398,N/A,HC SURGICEL HEMOSTAT 2X3,272,1 ,$91.00 ,$59.15 ,$25.48 ,$91.00 ,$59.15 , N/A ,$25.48 ,$46.05 , N/A ,$52.33 , N/A ,$46.04 , N/A , N/A ,$74.62 , N/A , N/A ,$77.35 ,$81.90 , N/A ,$68.25 ,$63.70 ,$67.34 ,$67.34 , N/A ,$77.35 , N/A , N/A ,$63.79 , N/A ,$37.86 , N/A ,$77.35 , N/A ,$25.48 ,$81.90 ,$48.05 , N/A ,$59.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205411,N/A,HC DRESSING ELASTIC NET,272,1 ,$115.00 ,$74.75 ,$32.20 ,$115.00 ,$74.75 , N/A ,$32.20 ,$58.19 , N/A ,$66.13 , N/A ,$58.18 , N/A , N/A ,$94.30 , N/A , N/A ,$97.75 ,$103.50 , N/A ,$86.25 ,$80.50 ,$85.10 ,$85.10 , N/A ,$97.75 , N/A , N/A ,$80.62 , N/A ,$47.84 , N/A ,$97.75 , N/A ,$32.20 ,$103.50 ,$60.72 , N/A ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205436,N/A,HC THERAPY PUTTY,272,1 ,$62.00 ,$40.30 ,$17.36 ,$62.00 ,$40.30 , N/A ,$17.36 ,$31.37 , N/A ,$35.65 , N/A ,$31.37 , N/A , N/A ,$50.84 , N/A , N/A ,$52.70 ,$55.80 , N/A ,$46.50 ,$43.40 ,$45.88 ,$45.88 , N/A ,$52.70 , N/A , N/A ,$43.46 , N/A ,$25.79 , N/A ,$52.70 , N/A ,$17.36 ,$55.80 ,$32.74 , N/A ,$40.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205494,N/A,HC REPLACEMENT PROC MODULES,272,1 ,$110.00 ,$71.50 ,$30.80 ,$110.00 ,$71.50 , N/A ,$30.80 ,$55.66 , N/A ,$63.25 , N/A ,$55.65 , N/A , N/A ,$90.20 , N/A , N/A ,$93.50 ,$99.00 , N/A ,$82.50 ,$77.00 ,$81.40 ,$81.40 , N/A ,$93.50 , N/A , N/A ,$77.11 , N/A ,$45.76 , N/A ,$93.50 , N/A ,$30.80 ,$99.00 ,$58.08 , N/A ,$71.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205498,N/A,HC MICROBIOLOGY QUICK TEST KIT,272,1 ,$791.00 ,$514.15 ,$221.48 ,$791.00 ,$514.15 , N/A ,$221.48 ,$400.25 , N/A ,$454.83 , N/A ,$400.17 , N/A , N/A ,$648.62 , N/A , N/A ,$672.35 ,$711.90 , N/A ,$593.25 ,$553.70 ,$585.34 ,$585.34 , N/A ,$672.35 , N/A , N/A ,$554.49 , N/A ,$329.06 , N/A ,$672.35 , N/A ,$221.48 ,$711.90 ,$417.65 , N/A ,$514.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205504,N/A,HC STEAM CHEMICAL INTEGRATOR,272,1 ,$22.00 ,$14.30 ,$6.16 ,$22.00 ,$14.30 , N/A ,$6.16 ,$11.13 , N/A ,$12.65 , N/A ,$11.13 , N/A , N/A ,$18.04 , N/A , N/A ,$18.70 ,$19.80 , N/A ,$16.50 ,$15.40 ,$16.28 ,$16.28 , N/A ,$18.70 , N/A , N/A ,$15.42 , N/A ,$9.15 , N/A ,$18.70 , N/A ,$6.16 ,$19.80 ,$11.62 , N/A ,$14.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205505,N/A,HC MEDI-FLOW LENS IRRIGATION SET,272,1 ,$20.00 ,$13.00 ,$5.60 ,$20.00 ,$13.00 , N/A ,$5.60 ,$10.12 , N/A ,$11.50 , N/A ,$10.12 , N/A , N/A ,$16.40 , N/A , N/A ,$17.00 ,$18.00 , N/A ,$15.00 ,$14.00 ,$14.80 ,$14.80 , N/A ,$17.00 , N/A , N/A ,$14.02 , N/A ,$8.32 , N/A ,$17.00 , N/A ,$5.60 ,$18.00 ,$10.56 , N/A ,$13.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205506,N/A,HC HEAT SEAL STERILIZATION POUCH,272,1 ,$41.00 ,$26.65 ,$11.48 ,$41.00 ,$26.65 , N/A ,$11.48 ,$20.75 , N/A ,$23.58 , N/A ,$20.74 , N/A , N/A ,$33.62 , N/A , N/A ,$34.85 ,$36.90 , N/A ,$30.75 ,$28.70 ,$30.34 ,$30.34 , N/A ,$34.85 , N/A , N/A ,$28.74 , N/A ,$17.06 , N/A ,$34.85 , N/A ,$11.48 ,$36.90 ,$21.65 , N/A ,$26.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205507,N/A,HC HEAT SEAL STERILIZATION TUBING,272,1 ,$30.00 ,$19.50 ,$8.40 ,$30.00 ,$19.50 , N/A ,$8.40 ,$15.18 , N/A ,$17.25 , N/A ,$15.18 , N/A , N/A ,$24.60 , N/A , N/A ,$25.50 ,$27.00 , N/A ,$22.50 ,$21.00 ,$22.20 ,$22.20 , N/A ,$25.50 , N/A , N/A ,$21.03 , N/A ,$12.48 , N/A ,$25.50 , N/A ,$8.40 ,$27.00 ,$15.84 , N/A ,$19.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27205509,N/A,HC CT SYRINGE KIT,272,1 ,$17.00 ,$11.05 ,$4.76 ,$17.00 ,$11.05 , N/A ,$4.76 ,$8.60 , N/A ,$9.78 , N/A ,$8.60 , N/A , N/A ,$13.94 , N/A , N/A ,$14.45 ,$15.30 , N/A ,$12.75 ,$11.90 ,$12.58 ,$12.58 , N/A ,$14.45 , N/A , N/A ,$11.92 , N/A ,$7.07 , N/A ,$14.45 , N/A ,$4.76 ,$15.30 ,$8.98 , N/A ,$11.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27280160,N/A,HC DETECTOR CO2,272,1 ,$20.00 ,$13.00 ,$5.60 ,$20.00 ,$13.00 , N/A ,$5.60 ,$10.12 , N/A ,$11.50 , N/A ,$10.12 , N/A , N/A ,$16.40 , N/A , N/A ,$17.00 ,$18.00 , N/A ,$15.00 ,$14.00 ,$14.80 ,$14.80 , N/A ,$17.00 , N/A , N/A ,$14.02 , N/A ,$8.32 , N/A ,$17.00 , N/A ,$5.60 ,$18.00 ,$10.56 , N/A ,$13.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27280183,N/A,HC KIT PATIENT POSITIONING PINK PAD,270,1 ,$255.00 ,$165.75 ,$71.40 ,$255.00 ,$165.75 , N/A ,$71.40 ,$129.03 , N/A ,$146.63 , N/A ,$129.00 , N/A , N/A ,$209.10 , N/A , N/A ,$216.75 ,$229.50 , N/A ,$191.25 ,$178.50 ,$188.70 ,$188.70 , N/A ,$216.75 , N/A , N/A ,$178.76 , N/A ,$106.08 , N/A ,$216.75 , N/A ,$71.40 ,$229.50 ,$134.64 , N/A ,$165.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27400003,L0120,HC CERVICAL COLLAR,274,1 ,$15.00 ,$9.75 ,$4.20 ,$63.30 ,$9.75 ,$25.32 ,$4.20 ,$7.59 ,$25.32 ,$8.63 ,$15.00 ,$7.59 ,$15.00 ,$15.00 ,$12.30 ,$63.30 ,$25.32 ,$12.75 ,$13.50 ,$25.32 ,$11.25 ,$10.50 ,$11.10 ,$11.10 ,$15.00 ,$12.75 ,$25.32 ,$25.32 ,$10.52 ,$25.32 ,$6.24 , N/A ,$12.75 ,$54.44 ,$4.20 ,$13.50 , N/A ,$25.32 ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27400035,L3650,HC CLAVICLE STRAP/FIT  AND  ADJ,274,1 ,$27.00 ,$17.55 ,$7.56 ,$151.88 ,$17.55 ,$60.75 ,$7.56 ,$13.66 ,$60.75 ,$15.53 ,$27.00 ,$13.66 ,$27.00 ,$27.00 ,$22.14 ,$151.88 ,$60.75 ,$22.95 ,$24.30 ,$60.75 ,$20.25 ,$18.90 ,$19.98 ,$19.98 ,$27.00 ,$22.95 ,$60.75 ,$60.75 ,$18.93 ,$60.75 ,$11.23 , N/A ,$22.95 ,$130.62 ,$7.56 ,$24.30 , N/A ,$60.75 ,$17.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27400039,L3670,HC SHOULDER IMMOBILIZER FIT  AND  ADJ,274,1 ,$27.00 ,$17.55 ,$7.56 ,$231.82 ,$17.55 ,$92.73 ,$7.56 ,$13.66 ,$92.73 ,$15.53 ,$27.00 ,$13.66 ,$27.00 ,$27.00 ,$22.14 ,$231.82 ,$92.73 ,$22.95 ,$24.30 ,$92.73 ,$20.25 ,$18.90 ,$19.98 ,$19.98 ,$27.00 ,$22.95 ,$92.73 ,$92.73 ,$18.93 ,$92.73 ,$11.23 , N/A ,$22.95 ,$199.37 ,$7.56 ,$24.30 , N/A ,$92.73 ,$17.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27400129,L1971,HC AFO ANKLE BRACE PREFAB,274,1 ,$24.00 ,$15.60 ,$6.72 ,"$1,001.10 ",$15.60 ,$400.44 ,$6.72 ,$12.14 ,$400.44 ,$13.80 ,$24.00 ,$12.14 ,$24.00 ,$24.00 ,$19.68 ,"$1,001.10 ",$400.44 ,$20.40 ,$21.60 ,$400.44 ,$18.00 ,$16.80 ,$17.76 ,$17.76 ,$24.00 ,$20.40 ,$400.44 ,$400.44 ,$16.82 ,$400.44 ,$9.98 , N/A ,$20.40 ,$860.95 ,$6.72 ,$21.60 , N/A ,$400.44 ,$15.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),27800181,C1763,HC ALLOGRAFT PASTE,278,1 ,$340.00 ,$221.00 ,$95.20 ,$340.00 ,$221.00 , N/A ,$95.20 ,$172.04 , N/A ,$195.50 , N/A ,$172.01 , N/A , N/A ,$278.80 , N/A , N/A ,$289.00 ,$306.00 , N/A ,$255.00 ,$238.00 ,$251.60 ,$251.60 , N/A ,$289.00 , N/A , N/A ,$238.34 , N/A ,$141.44 , N/A ,$289.00 , N/A ,$95.20 ,$306.00 , N/A , N/A ,$221.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),29200003,N/A,HC CRUTCHES PER PAIR,271,1 ,$29.00 ,$18.85 ,$8.12 ,$29.00 ,$18.85 , N/A ,$8.12 ,$14.67 , N/A ,$16.68 , N/A ,$14.67 , N/A , N/A ,$23.78 , N/A , N/A ,$24.65 ,$26.10 , N/A ,$21.75 ,$20.30 ,$21.46 ,$21.46 , N/A ,$24.65 , N/A , N/A ,$20.33 , N/A ,$12.06 , N/A ,$24.65 , N/A ,$8.12 ,$26.10 ,$15.31 , N/A ,$18.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$56.00 ,$36.40 ,$6.28 ,$56.00 ,$36.40 , N/A ,$15.68 ,$28.34 , N/A ,$32.20 , N/A ,$28.33 , N/A , N/A ,$45.92 , N/A , N/A ,$47.60 ,$50.40 , N/A ,$42.00 ,$39.20 ,$41.44 ,$41.44 , N/A ,$47.60 , N/A , N/A ,$39.26 , N/A ,$23.30 , N/A ,$47.60 , N/A ,$15.68 ,$50.40 ,$6.28 , N/A ,$36.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30000010,36415,HC VENIPUNCTURE,300,1 ,$33.00 ,$21.45 ,$3.00 ,$33.00 ,$21.45 ,$3.00 ,$9.24 ,$16.70 ,$3.00 ,$18.98 ,$3.00 ,$16.69 ,$3.00 ,$5.70 ,$27.06 ,$7.50 ,$3.00 ,$28.05 ,$29.70 ,$3.00 ,$24.75 ,$23.10 ,$24.42 ,$24.42 ,$7.50 ,$28.05 ,$3.00 ,$3.00 ,$23.13 ,$3.00 ,$13.73 , N/A ,$28.05 ,$6.45 ,$9.24 ,$29.70 ,$6.00 ,$3.00 ,$21.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$81.00 ,$52.65 ,$22.68 ,$277.92 ,$52.65 ,$111.17 ,$22.68 ,$40.99 ,$111.17 ,$46.58 ,$81.00 ,$40.98 ,$81.00 ,$81.00 ,$66.42 ,$277.92 ,$111.17 ,$68.85 ,$72.90 ,$111.17 ,$60.75 ,$56.70 ,$59.94 ,$59.94 ,$81.00 ,$68.85 ,$111.17 ,$111.17 ,$56.78 ,$111.17 ,$33.70 , N/A ,$68.85 ,$239.01 ,$22.68 ,$72.90 , N/A ,$111.17 ,$52.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30000242,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$215.00 ,$139.75 ,$60.20 ,$277.92 ,$139.75 ,$111.17 ,$60.20 ,$108.79 ,$111.17 ,$123.63 ,$111.17 ,$108.77 ,$111.17 ,$211.22 ,$176.30 ,$277.92 ,$111.17 ,$182.75 ,$193.50 ,$111.17 ,$161.25 ,$150.50 ,$159.10 ,$159.10 ,$215.00 ,$182.75 ,$111.17 ,$111.17 ,$150.72 ,$111.17 ,$89.44 , N/A ,$182.75 ,$239.01 ,$60.20 ,$193.50 , N/A ,$111.17 ,$139.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30002013,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$215.00 ,$139.75 ,$60.20 ,$277.92 ,$139.75 ,$111.17 ,$60.20 ,$108.79 ,$111.17 ,$123.63 ,$111.17 ,$108.77 ,$111.17 ,$211.22 ,$176.30 ,$277.92 ,$111.17 ,$182.75 ,$193.50 ,$111.17 ,$161.25 ,$150.50 ,$159.10 ,$159.10 ,$215.00 ,$182.75 ,$111.17 ,$111.17 ,$150.72 ,$111.17 ,$89.44 , N/A ,$182.75 ,$239.01 ,$60.20 ,$193.50 , N/A ,$111.17 ,$139.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30002016,89051,HC CELL CT BODY FLUID W/DIFF T2,300,1 ,$212.00 ,$137.80 ,$5.60 ,$212.00 ,$137.80 ,$5.60 ,$59.36 ,$107.27 ,$5.60 ,$121.90 ,$5.60 ,$107.25 ,$5.60 ,$10.64 ,$173.84 ,$14.00 ,$5.60 ,$180.20 ,$190.80 ,$5.60 ,$159.00 ,$148.40 ,$156.88 ,$156.88 ,$14.00 ,$180.20 ,$5.60 ,$5.60 ,$148.61 ,$5.60 ,$88.19 , N/A ,$180.20 ,$12.04 ,$59.36 ,$190.80 ,$11.20 ,$5.60 ,$137.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30002018,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$90.00 ,$58.50 ,$7.33 ,$90.00 ,$58.50 ,$7.33 ,$25.20 ,$45.54 ,$7.33 ,$51.75 ,$7.33 ,$45.53 ,$7.33 ,$13.93 ,$73.80 ,$18.33 ,$7.33 ,$76.50 ,$81.00 ,$7.33 ,$67.50 ,$63.00 ,$66.60 ,$66.60 ,$18.33 ,$76.50 ,$7.33 ,$7.33 ,$63.09 ,$7.33 ,$37.44 , N/A ,$76.50 ,$15.76 ,$25.20 ,$81.00 ,$14.66 ,$7.33 ,$58.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30002039,86999,HC TRANSFUSION UNLISTED PROCEDURE -90,300,1 ,$63.00 ,$40.95 ,$17.64 ,$63.00 ,$40.95 ,$24.36 ,$17.64 ,$31.88 ,$24.36 ,$36.23 ,$24.36 ,$31.87 ,$24.36 ,$46.27 ,$51.66 ,$60.89 ,$24.36 ,$53.55 ,$56.70 ,$24.36 ,$47.25 ,$44.10 ,$46.62 ,$46.62 ,$60.89 ,$53.55 ,$24.36 ,$24.36 ,$44.16 ,$24.36 ,$26.21 , N/A ,$53.55 ,$52.36 ,$17.64 ,$56.70 ,$49.34 ,$24.36 ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100121,80164,HC VALPROIC ACID,301,1 ,$177.00 ,$115.05 ,$13.54 ,$177.00 ,$115.05 ,$13.54 ,$49.56 ,$89.56 ,$13.54 ,$101.78 ,$13.54 ,$89.54 ,$13.54 ,$25.73 ,$145.14 ,$33.85 ,$13.54 ,$150.45 ,$159.30 ,$13.54 ,$132.75 ,$123.90 ,$130.98 ,$130.98 ,$33.85 ,$150.45 ,$13.54 ,$13.54 ,$124.08 ,$13.54 ,$73.63 , N/A ,$150.45 ,$29.11 ,$49.56 ,$159.30 ,$27.08 ,$13.54 ,$115.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100157,82009,HC ACETONE SERUM,301,1 ,$72.00 ,$46.80 ,$4.52 ,$72.00 ,$46.80 ,$4.52 ,$20.16 ,$36.43 ,$4.52 ,$41.40 ,$4.52 ,$36.42 ,$4.52 ,$8.59 ,$59.04 ,$11.30 ,$4.52 ,$61.20 ,$64.80 ,$4.52 ,$54.00 ,$50.40 ,$53.28 ,$53.28 ,$11.30 ,$61.20 ,$4.52 ,$4.52 ,$50.47 ,$4.52 ,$29.95 , N/A ,$61.20 ,$9.72 ,$20.16 ,$64.80 ,$9.04 ,$4.52 ,$46.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100165,82040,HC ALBUMIN SERUM,301,1 ,$75.00 ,$48.75 ,$4.95 ,$75.00 ,$48.75 ,$4.95 ,$21.00 ,$37.95 ,$4.95 ,$43.13 ,$4.95 ,$37.94 ,$4.95 ,$9.41 ,$61.50 ,$12.38 ,$4.95 ,$63.75 ,$67.50 ,$4.95 ,$56.25 ,$52.50 ,$55.50 ,$55.50 ,$12.38 ,$63.75 ,$4.95 ,$4.95 ,$52.58 ,$4.95 ,$31.20 , N/A ,$63.75 ,$10.64 ,$21.00 ,$67.50 ,$9.90 ,$4.95 ,$48.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$100.00 ,$65.00 ,$5.78 ,$100.00 ,$65.00 ,$5.78 ,$28.00 ,$50.60 ,$5.78 ,$57.50 ,$5.78 ,$50.59 ,$5.78 ,$10.98 ,$82.00 ,$14.45 ,$5.78 ,$85.00 ,$90.00 ,$5.78 ,$75.00 ,$70.00 ,$74.00 ,$74.00 ,$14.45 ,$85.00 ,$5.78 ,$5.78 ,$70.10 ,$5.78 ,$41.60 , N/A ,$85.00 ,$12.43 ,$28.00 ,$90.00 ,$11.56 ,$5.78 ,$65.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100186,82140,HC AMMONIA,301,1 ,$126.00 ,$81.90 ,$14.57 ,$126.00 ,$81.90 ,$14.57 ,$35.28 ,$63.76 ,$14.57 ,$72.45 ,$14.57 ,$63.74 ,$14.57 ,$27.68 ,$103.32 ,$36.43 ,$14.57 ,$107.10 ,$113.40 ,$14.57 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$36.43 ,$107.10 ,$14.57 ,$14.57 ,$88.33 ,$14.57 ,$52.42 , N/A ,$107.10 ,$31.33 ,$35.28 ,$113.40 ,$29.14 ,$14.57 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100188,82150,HC AMYLASE,301,1 ,$131.00 ,$85.15 ,$6.48 ,$131.00 ,$85.15 ,$6.48 ,$36.68 ,$66.29 ,$6.48 ,$75.33 ,$6.48 ,$66.27 ,$6.48 ,$12.31 ,$107.42 ,$16.20 ,$6.48 ,$111.35 ,$117.90 ,$6.48 ,$98.25 ,$91.70 ,$96.94 ,$96.94 ,$16.20 ,$111.35 ,$6.48 ,$6.48 ,$91.83 ,$6.48 ,$54.50 , N/A ,$111.35 ,$13.93 ,$36.68 ,$117.90 ,$12.96 ,$6.48 ,$85.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$77.00 ,$50.05 ,$5.02 ,$77.00 ,$50.05 ,$5.02 ,$21.56 ,$38.96 ,$5.02 ,$44.28 ,$5.02 ,$38.95 ,$5.02 ,$9.54 ,$63.14 ,$12.55 ,$5.02 ,$65.45 ,$69.30 ,$5.02 ,$57.75 ,$53.90 ,$56.98 ,$56.98 ,$12.55 ,$65.45 ,$5.02 ,$5.02 ,$53.98 ,$5.02 ,$32.03 , N/A ,$65.45 ,$10.79 ,$21.56 ,$69.30 ,$10.04 ,$5.02 ,$50.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$87.00 ,$56.55 ,$5.02 ,$87.00 ,$56.55 ,$5.02 ,$24.36 ,$44.02 ,$5.02 ,$50.03 ,$5.02 ,$44.01 ,$5.02 ,$9.54 ,$71.34 ,$12.55 ,$5.02 ,$73.95 ,$78.30 ,$5.02 ,$65.25 ,$60.90 ,$64.38 ,$64.38 ,$12.55 ,$73.95 ,$5.02 ,$5.02 ,$60.99 ,$5.02 ,$36.19 , N/A ,$73.95 ,$10.79 ,$24.36 ,$78.30 ,$10.04 ,$5.02 ,$56.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100212,82306,HC VITAMIN D 25 OH,301,1 ,$290.00 ,$188.50 ,$29.60 ,$290.00 ,$188.50 ,$29.60 ,$81.20 ,$146.74 ,$29.60 ,$166.75 ,$29.60 ,$146.71 ,$29.60 ,$56.24 ,$237.80 ,$74.00 ,$29.60 ,$246.50 ,$261.00 ,$29.60 ,$217.50 ,$203.00 ,$214.60 ,$214.60 ,$74.00 ,$246.50 ,$29.60 ,$29.60 ,$203.29 ,$29.60 ,$120.64 , N/A ,$246.50 ,$63.64 ,$81.20 ,$261.00 ,$59.20 ,$29.60 ,$188.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100214,82310,HC CALCIUM,301,1 ,$98.00 ,$63.70 ,$5.16 ,$98.00 ,$63.70 ,$5.16 ,$27.44 ,$49.59 ,$5.16 ,$56.35 ,$5.16 ,$49.58 ,$5.16 ,$9.80 ,$80.36 ,$12.90 ,$5.16 ,$83.30 ,$88.20 ,$5.16 ,$73.50 ,$68.60 ,$72.52 ,$72.52 ,$12.90 ,$83.30 ,$5.16 ,$5.16 ,$68.70 ,$5.16 ,$40.77 , N/A ,$83.30 ,$11.09 ,$27.44 ,$88.20 ,$10.32 ,$5.16 ,$63.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$105.00 ,$68.25 ,$6.03 ,$105.00 ,$68.25 ,$6.03 ,$29.40 ,$53.13 ,$6.03 ,$60.38 ,$6.03 ,$53.12 ,$6.03 ,$11.46 ,$86.10 ,$15.08 ,$6.03 ,$89.25 ,$94.50 ,$6.03 ,$78.75 ,$73.50 ,$77.70 ,$77.70 ,$15.08 ,$89.25 ,$6.03 ,$6.03 ,$73.61 ,$6.03 ,$43.68 , N/A ,$89.25 ,$12.96 ,$29.40 ,$94.50 ,$12.06 ,$6.03 ,$68.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100222,82374,HC BICARBONATE,301,1 ,$52.00 ,$33.80 ,$4.88 ,$52.00 ,$33.80 ,$4.88 ,$14.56 ,$26.31 ,$4.88 ,$29.90 ,$4.88 ,$26.31 ,$4.88 ,$9.27 ,$42.64 ,$12.20 ,$4.88 ,$44.20 ,$46.80 ,$4.88 ,$39.00 ,$36.40 ,$38.48 ,$38.48 ,$12.20 ,$44.20 ,$4.88 ,$4.88 ,$36.45 ,$4.88 ,$21.63 , N/A ,$44.20 ,$10.49 ,$14.56 ,$46.80 ,$9.76 ,$4.88 ,$33.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100237,82435,HC CHLORIDE,301,1 ,$52.00 ,$33.80 ,$4.60 ,$52.00 ,$33.80 ,$4.60 ,$14.56 ,$26.31 ,$4.60 ,$29.90 ,$4.60 ,$26.31 ,$4.60 ,$8.74 ,$42.64 ,$11.50 ,$4.60 ,$44.20 ,$46.80 ,$4.60 ,$39.00 ,$36.40 ,$38.48 ,$38.48 ,$11.50 ,$44.20 ,$4.60 ,$4.60 ,$36.45 ,$4.60 ,$21.63 , N/A ,$44.20 ,$9.89 ,$14.56 ,$46.80 ,$9.20 ,$4.60 ,$33.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100238,82436,HC CHLORIDE URINE,301,1 ,$60.00 ,$39.00 ,$5.75 ,$60.00 ,$39.00 ,$5.75 ,$16.80 ,$30.36 ,$5.75 ,$34.50 ,$5.75 ,$30.35 ,$5.75 ,$10.93 ,$49.20 ,$14.38 ,$5.75 ,$51.00 ,$54.00 ,$5.75 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$14.38 ,$51.00 ,$5.75 ,$5.75 ,$42.06 ,$5.75 ,$24.96 , N/A ,$51.00 ,$12.36 ,$16.80 ,$54.00 ,$11.50 ,$5.75 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100241,82465,HC CHOLESTEROL,301,1 ,$88.00 ,$57.20 ,$4.35 ,$88.00 ,$57.20 ,$4.35 ,$24.64 ,$44.53 ,$4.35 ,$50.60 ,$4.35 ,$44.52 ,$4.35 ,$8.27 ,$72.16 ,$10.88 ,$4.35 ,$74.80 ,$79.20 ,$4.35 ,$66.00 ,$61.60 ,$65.12 ,$65.12 ,$10.88 ,$74.80 ,$4.35 ,$4.35 ,$61.69 ,$4.35 ,$36.61 , N/A ,$74.80 ,$9.35 ,$24.64 ,$79.20 ,$8.70 ,$4.35 ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$131.00 ,$85.15 ,$6.51 ,$131.00 ,$85.15 ,$6.51 ,$36.68 ,$66.29 ,$6.51 ,$75.33 ,$6.51 ,$66.27 ,$6.51 ,$12.37 ,$107.42 ,$16.28 ,$6.51 ,$111.35 ,$117.90 ,$6.51 ,$98.25 ,$91.70 ,$96.94 ,$96.94 ,$16.28 ,$111.35 ,$6.51 ,$6.51 ,$91.83 ,$6.51 ,$54.50 , N/A ,$111.35 ,$14.00 ,$36.68 ,$117.90 ,$13.02 ,$6.51 ,$85.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100262,82565,HC CREATININE,301,1 ,$79.00 ,$51.35 ,$5.12 ,$79.00 ,$51.35 ,$5.12 ,$22.12 ,$39.97 ,$5.12 ,$45.43 ,$5.12 ,$39.97 ,$5.12 ,$9.73 ,$64.78 ,$12.80 ,$5.12 ,$67.15 ,$71.10 ,$5.12 ,$59.25 ,$55.30 ,$58.46 ,$58.46 ,$12.80 ,$67.15 ,$5.12 ,$5.12 ,$55.38 ,$5.12 ,$32.86 , N/A ,$67.15 ,$11.01 ,$22.12 ,$71.10 ,$10.24 ,$5.12 ,$51.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$97.00 ,$63.05 ,$5.18 ,$97.00 ,$63.05 ,$5.18 ,$27.16 ,$49.08 ,$5.18 ,$55.78 ,$5.18 ,$49.07 ,$5.18 ,$9.84 ,$79.54 ,$12.95 ,$5.18 ,$82.45 ,$87.30 ,$5.18 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$12.95 ,$82.45 ,$5.18 ,$5.18 ,$68.00 ,$5.18 ,$40.35 , N/A ,$82.45 ,$11.14 ,$27.16 ,$87.30 ,$10.36 ,$5.18 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100266,82575,HC CREATININE CLEARANCE,301,1 ,$40.00 ,$26.00 ,$9.46 ,$40.00 ,$26.00 ,$9.46 ,$11.20 ,$20.24 ,$9.46 ,$23.00 ,$9.46 ,$20.24 ,$9.46 ,$17.97 ,$32.80 ,$23.65 ,$9.46 ,$34.00 ,$36.00 ,$9.46 ,$30.00 ,$28.00 ,$29.60 ,$29.60 ,$23.65 ,$34.00 ,$9.46 ,$9.46 ,$28.04 ,$9.46 ,$16.64 , N/A ,$34.00 ,$20.34 ,$11.20 ,$36.00 ,$18.92 ,$9.46 ,$26.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100269,82607,HC VITAMIN B12,301,1 ,$196.00 ,$127.40 ,$15.08 ,$196.00 ,$127.40 ,$15.08 ,$54.88 ,$99.18 ,$15.08 ,$112.70 ,$15.08 ,$99.16 ,$15.08 ,$28.65 ,$160.72 ,$37.70 ,$15.08 ,$166.60 ,$176.40 ,$15.08 ,$147.00 ,$137.20 ,$145.04 ,$145.04 ,$37.70 ,$166.60 ,$15.08 ,$15.08 ,$137.40 ,$15.08 ,$81.54 , N/A ,$166.60 ,$32.42 ,$54.88 ,$176.40 ,$30.16 ,$15.08 ,$127.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100290,82728,HC FERRITIN,301,1 ,$166.00 ,$107.90 ,$13.63 ,$166.00 ,$107.90 ,$13.63 ,$46.48 ,$84.00 ,$13.63 ,$95.45 ,$13.63 ,$83.98 ,$13.63 ,$25.90 ,$136.12 ,$34.08 ,$13.63 ,$141.10 ,$149.40 ,$13.63 ,$124.50 ,$116.20 ,$122.84 ,$122.84 ,$34.08 ,$141.10 ,$13.63 ,$13.63 ,$116.37 ,$13.63 ,$69.06 , N/A ,$141.10 ,$29.30 ,$46.48 ,$149.40 ,$27.26 ,$13.63 ,$107.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100292,82746,HC FOLIC ACID SERUM,301,1 ,$167.00 ,$108.55 ,$14.70 ,$167.00 ,$108.55 ,$14.70 ,$46.76 ,$84.50 ,$14.70 ,$96.03 ,$14.70 ,$84.49 ,$14.70 ,$27.93 ,$136.94 ,$36.75 ,$14.70 ,$141.95 ,$150.30 ,$14.70 ,$125.25 ,$116.90 ,$123.58 ,$123.58 ,$36.75 ,$141.95 ,$14.70 ,$14.70 ,$117.07 ,$14.70 ,$69.47 , N/A ,$141.95 ,$31.61 ,$46.76 ,$150.30 ,$29.40 ,$14.70 ,$108.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100307,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$359.00 ,$233.35 ,$78.77 ,$359.00 ,$233.35 ,$78.77 ,$100.52 ,$181.65 ,$78.77 ,$206.43 ,$78.77 ,$181.62 ,$78.77 ,$149.66 ,$294.38 ,$196.93 ,$78.77 ,$305.15 ,$323.10 ,$78.77 ,$269.25 ,$251.30 ,$265.66 ,$265.66 ,$196.93 ,$305.15 ,$78.77 ,$78.77 ,$251.66 ,$78.77 ,$149.34 , N/A ,$305.15 ,$169.36 ,$100.52 ,$323.10 ,$157.54 ,$78.77 ,$233.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$83.00 ,$53.95 ,$3.93 ,$83.00 ,$53.95 ,$3.93 ,$23.24 ,$42.00 ,$3.93 ,$47.73 ,$3.93 ,$41.99 ,$3.93 ,$7.47 ,$68.06 ,$9.83 ,$3.93 ,$70.55 ,$74.70 ,$3.93 ,$62.25 ,$58.10 ,$61.42 ,$61.42 ,$9.83 ,$70.55 ,$3.93 ,$3.93 ,$58.18 ,$3.93 ,$34.53 , N/A ,$70.55 ,$8.45 ,$23.24 ,$74.70 ,$7.86 ,$3.93 ,$53.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100312,82947,HC GLUCOSE,301,1 ,$65.00 ,$42.25 ,$3.93 ,$65.00 ,$42.25 ,$3.93 ,$18.20 ,$32.89 ,$3.93 ,$37.38 ,$3.93 ,$32.88 ,$3.93 ,$7.47 ,$53.30 ,$9.83 ,$3.93 ,$55.25 ,$58.50 ,$3.93 ,$48.75 ,$45.50 ,$48.10 ,$48.10 ,$9.83 ,$55.25 ,$3.93 ,$3.93 ,$45.57 ,$3.93 ,$27.04 , N/A ,$55.25 ,$8.45 ,$18.20 ,$58.50 ,$7.86 ,$3.93 ,$42.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100313,82950,HC GLUCOSE SCREEN,301,1 ,$87.00 ,$56.55 ,$4.75 ,$87.00 ,$56.55 ,$4.75 ,$24.36 ,$44.02 ,$4.75 ,$50.03 ,$4.75 ,$44.01 ,$4.75 ,$9.03 ,$71.34 ,$11.88 ,$4.75 ,$73.95 ,$78.30 ,$4.75 ,$65.25 ,$60.90 ,$64.38 ,$64.38 ,$11.88 ,$73.95 ,$4.75 ,$4.75 ,$60.99 ,$4.75 ,$36.19 , N/A ,$73.95 ,$10.21 ,$24.36 ,$78.30 ,$9.50 ,$4.75 ,$56.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$218.00 ,$141.70 ,$12.87 ,$218.00 ,$141.70 ,$12.87 ,$61.04 ,$110.31 ,$12.87 ,$125.35 ,$12.87 ,$110.29 ,$12.87 ,$24.45 ,$178.76 ,$32.18 ,$12.87 ,$185.30 ,$196.20 ,$12.87 ,$163.50 ,$152.60 ,$161.32 ,$161.32 ,$32.18 ,$185.30 ,$12.87 ,$12.87 ,$152.82 ,$12.87 ,$90.69 , N/A ,$185.30 ,$27.67 ,$61.04 ,$196.20 ,$25.74 ,$12.87 ,$141.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$60.00 ,$39.00 ,$3.92 ,$60.00 ,$39.00 ,$3.92 ,$16.80 ,$30.36 ,$3.92 ,$34.50 ,$3.92 ,$30.35 ,$3.92 ,$7.45 ,$49.20 ,$9.80 ,$3.92 ,$51.00 ,$54.00 ,$3.92 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$9.80 ,$51.00 ,$3.92 ,$3.92 ,$42.06 ,$3.92 ,$24.96 , N/A ,$51.00 ,$8.43 ,$16.80 ,$54.00 ,$7.84 ,$3.92 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100319,82977,HC GGT/GGTP,301,1 ,$116.00 ,$75.40 ,$7.20 ,$116.00 ,$75.40 ,$7.20 ,$32.48 ,$58.70 ,$7.20 ,$66.70 ,$7.20 ,$58.68 ,$7.20 ,$13.68 ,$95.12 ,$18.00 ,$7.20 ,$98.60 ,$104.40 ,$7.20 ,$87.00 ,$81.20 ,$85.84 ,$85.84 ,$18.00 ,$98.60 ,$7.20 ,$7.20 ,$81.32 ,$7.20 ,$48.26 , N/A ,$98.60 ,$15.48 ,$32.48 ,$104.40 ,$14.40 ,$7.20 ,$75.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$150.00 ,$97.50 ,$9.71 ,$150.00 ,$97.50 ,$9.71 ,$42.00 ,$75.90 ,$9.71 ,$86.25 ,$9.71 ,$75.89 ,$9.71 ,$18.45 ,$123.00 ,$24.28 ,$9.71 ,$127.50 ,$135.00 ,$9.71 ,$112.50 ,$105.00 ,$111.00 ,$111.00 ,$24.28 ,$127.50 ,$9.71 ,$9.71 ,$105.15 ,$9.71 ,$62.40 , N/A ,$127.50 ,$20.88 ,$42.00 ,$135.00 ,$19.42 ,$9.71 ,$97.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100393,83540,HC IRON TOTAL,301,1 ,$120.00 ,$78.00 ,$6.47 ,$120.00 ,$78.00 ,$6.47 ,$33.60 ,$60.72 ,$6.47 ,$69.00 ,$6.47 ,$60.71 ,$6.47 ,$12.29 ,$98.40 ,$16.18 ,$6.47 ,$102.00 ,$108.00 ,$6.47 ,$90.00 ,$84.00 ,$88.80 ,$88.80 ,$16.18 ,$102.00 ,$6.47 ,$6.47 ,$84.12 ,$6.47 ,$49.92 , N/A ,$102.00 ,$13.91 ,$33.60 ,$108.00 ,$12.94 ,$6.47 ,$78.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$136.00 ,$88.40 ,$8.74 ,$136.00 ,$88.40 ,$8.74 ,$38.08 ,$68.82 ,$8.74 ,$78.20 ,$8.74 ,$68.80 ,$8.74 ,$16.61 ,$111.52 ,$21.85 ,$8.74 ,$115.60 ,$122.40 ,$8.74 ,$102.00 ,$95.20 ,$100.64 ,$100.64 ,$21.85 ,$115.60 ,$8.74 ,$8.74 ,$95.34 ,$8.74 ,$56.58 , N/A ,$115.60 ,$18.79 ,$38.08 ,$122.40 ,$17.48 ,$8.74 ,$88.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$133.00 ,$86.45 ,$11.57 ,$133.00 ,$86.45 ,$11.57 ,$37.24 ,$67.30 ,$11.57 ,$76.48 ,$11.57 ,$67.28 ,$11.57 ,$21.98 ,$109.06 ,$28.93 ,$11.57 ,$113.05 ,$119.70 ,$11.57 ,$99.75 ,$93.10 ,$98.42 ,$98.42 ,$28.93 ,$113.05 ,$11.57 ,$11.57 ,$93.23 ,$11.57 ,$55.33 , N/A ,$113.05 ,$24.88 ,$37.24 ,$119.70 ,$23.14 ,$11.57 ,$86.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$99.00 ,$64.35 ,$6.04 ,$99.00 ,$64.35 ,$6.04 ,$27.72 ,$50.09 ,$6.04 ,$56.93 ,$6.04 ,$50.08 ,$6.04 ,$11.48 ,$81.18 ,$15.10 ,$6.04 ,$84.15 ,$89.10 ,$6.04 ,$74.25 ,$69.30 ,$73.26 ,$73.26 ,$15.10 ,$84.15 ,$6.04 ,$6.04 ,$69.40 ,$6.04 ,$41.18 , N/A ,$84.15 ,$12.99 ,$27.72 ,$89.10 ,$12.08 ,$6.04 ,$64.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100409,83690,HC LIPASE,301,1 ,$155.00 ,$100.75 ,$6.89 ,$155.00 ,$100.75 ,$6.89 ,$43.40 ,$78.43 ,$6.89 ,$89.13 ,$6.89 ,$78.41 ,$6.89 ,$13.09 ,$127.10 ,$17.23 ,$6.89 ,$131.75 ,$139.50 ,$6.89 ,$116.25 ,$108.50 ,$114.70 ,$114.70 ,$17.23 ,$131.75 ,$6.89 ,$6.89 ,$108.66 ,$6.89 ,$64.48 , N/A ,$131.75 ,$14.81 ,$43.40 ,$139.50 ,$13.78 ,$6.89 ,$100.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100415,83718,HC CHOLESTEROL HDL,301,1 ,$72.00 ,$46.80 ,$8.19 ,$72.00 ,$46.80 ,$8.19 ,$20.16 ,$36.43 ,$8.19 ,$41.40 ,$8.19 ,$36.42 ,$8.19 ,$15.56 ,$59.04 ,$20.48 ,$8.19 ,$61.20 ,$64.80 ,$8.19 ,$54.00 ,$50.40 ,$53.28 ,$53.28 ,$20.48 ,$61.20 ,$8.19 ,$8.19 ,$50.47 ,$8.19 ,$29.95 , N/A ,$61.20 ,$17.61 ,$20.16 ,$64.80 ,$16.38 ,$8.19 ,$46.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100417,83735,HC MAGNESIUM,301,1 ,$116.00 ,$75.40 ,$6.70 ,$116.00 ,$75.40 ,$6.70 ,$32.48 ,$58.70 ,$6.70 ,$66.70 ,$6.70 ,$58.68 ,$6.70 ,$12.73 ,$95.12 ,$16.75 ,$6.70 ,$98.60 ,$104.40 ,$6.70 ,$87.00 ,$81.20 ,$85.84 ,$85.84 ,$16.75 ,$98.60 ,$6.70 ,$6.70 ,$81.32 ,$6.70 ,$48.26 , N/A ,$98.60 ,$14.41 ,$32.48 ,$104.40 ,$13.40 ,$6.70 ,$75.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$336.00 ,$218.40 ,$39.26 ,$336.00 ,$218.40 ,$39.26 ,$94.08 ,$170.02 ,$39.26 ,$193.20 ,$39.26 ,$169.98 ,$39.26 ,$74.59 ,$275.52 ,$98.15 ,$39.26 ,$285.60 ,$302.40 ,$39.26 ,$252.00 ,$235.20 ,$248.64 ,$248.64 ,$98.15 ,$285.60 ,$39.26 ,$39.26 ,$235.54 ,$39.26 ,$139.78 , N/A ,$285.60 ,$84.41 ,$94.08 ,$302.40 ,$78.52 ,$39.26 ,$218.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$76.00 ,$49.40 ,$5.18 ,$76.00 ,$49.40 ,$5.18 ,$21.28 ,$38.46 ,$5.18 ,$43.70 ,$5.18 ,$38.45 ,$5.18 ,$9.84 ,$62.32 ,$12.95 ,$5.18 ,$64.60 ,$68.40 ,$5.18 ,$57.00 ,$53.20 ,$56.24 ,$56.24 ,$12.95 ,$64.60 ,$5.18 ,$5.18 ,$53.28 ,$5.18 ,$31.62 , N/A ,$64.60 ,$11.14 ,$21.28 ,$68.40 ,$10.36 ,$5.18 ,$49.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100684,84100,HC PHOSPHORUS,301,1 ,$106.00 ,$68.90 ,$4.74 ,$106.00 ,$68.90 ,$4.74 ,$29.68 ,$53.64 ,$4.74 ,$60.95 ,$4.74 ,$53.63 ,$4.74 ,$9.01 ,$86.92 ,$11.85 ,$4.74 ,$90.10 ,$95.40 ,$4.74 ,$79.50 ,$74.20 ,$78.44 ,$78.44 ,$11.85 ,$90.10 ,$4.74 ,$4.74 ,$74.31 ,$4.74 ,$44.10 , N/A ,$90.10 ,$10.19 ,$29.68 ,$95.40 ,$9.48 ,$4.74 ,$68.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100691,84132,HC POTASSIUM,301,1 ,$63.00 ,$40.95 ,$4.76 ,$63.00 ,$40.95 ,$4.76 ,$17.64 ,$31.88 ,$4.76 ,$36.23 ,$4.76 ,$31.87 ,$4.76 ,$9.04 ,$51.66 ,$11.90 ,$4.76 ,$53.55 ,$56.70 ,$4.76 ,$47.25 ,$44.10 ,$46.62 ,$46.62 ,$11.90 ,$53.55 ,$4.76 ,$4.76 ,$44.16 ,$4.76 ,$26.21 , N/A ,$53.55 ,$10.23 ,$17.64 ,$56.70 ,$9.52 ,$4.76 ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100694,84133,HC POTASSIUM URINE,301,1 ,$174.00 ,$113.10 ,$4.73 ,$174.00 ,$113.10 ,$4.73 ,$48.72 ,$88.04 ,$4.73 ,$100.05 ,$4.73 ,$88.03 ,$4.73 ,$8.99 ,$142.68 ,$11.83 ,$4.73 ,$147.90 ,$156.60 ,$4.73 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$11.83 ,$147.90 ,$4.73 ,$4.73 ,$121.97 ,$4.73 ,$72.38 , N/A ,$147.90 ,$10.17 ,$48.72 ,$156.60 ,$9.46 ,$4.73 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100698,84153,HC PSA TOTAL,301,1 ,$174.00 ,$113.10 ,$18.39 ,$174.00 ,$113.10 ,$18.39 ,$48.72 ,$88.04 ,$18.39 ,$100.05 ,$18.39 ,$88.03 ,$18.39 ,$34.94 ,$142.68 ,$45.98 ,$18.39 ,$147.90 ,$156.60 ,$18.39 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$45.98 ,$147.90 ,$18.39 ,$18.39 ,$121.97 ,$18.39 ,$72.38 , N/A ,$147.90 ,$39.54 ,$48.72 ,$156.60 ,$36.78 ,$18.39 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100700,84155,HC PROTEIN TOTAL,301,1 ,$174.00 ,$113.10 ,$3.67 ,$174.00 ,$113.10 ,$3.67 ,$48.72 ,$88.04 ,$3.67 ,$100.05 ,$3.67 ,$88.03 ,$3.67 ,$6.97 ,$142.68 ,$9.18 ,$3.67 ,$147.90 ,$156.60 ,$3.67 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$9.18 ,$147.90 ,$3.67 ,$3.67 ,$121.97 ,$3.67 ,$72.38 , N/A ,$147.90 ,$7.89 ,$48.72 ,$156.60 ,$7.34 ,$3.67 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$102.00 ,$66.30 ,$3.67 ,$102.00 ,$66.30 ,$3.67 ,$28.56 ,$51.61 ,$3.67 ,$58.65 ,$3.67 ,$51.60 ,$3.67 ,$6.97 ,$83.64 ,$9.18 ,$3.67 ,$86.70 ,$91.80 ,$3.67 ,$76.50 ,$71.40 ,$75.48 ,$75.48 ,$9.18 ,$86.70 ,$3.67 ,$3.67 ,$71.50 ,$3.67 ,$42.43 , N/A ,$86.70 ,$7.89 ,$28.56 ,$91.80 ,$7.34 ,$3.67 ,$66.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$174.00 ,$113.10 ,$4.00 ,$174.00 ,$113.10 ,$4.00 ,$48.72 ,$88.04 ,$4.00 ,$100.05 ,$4.00 ,$88.03 ,$4.00 ,$7.60 ,$142.68 ,$10.00 ,$4.00 ,$147.90 ,$156.60 ,$4.00 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$10.00 ,$147.90 ,$4.00 ,$4.00 ,$121.97 ,$4.00 ,$72.38 , N/A ,$147.90 ,$8.60 ,$48.72 ,$156.60 ,$8.00 ,$4.00 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100721,84295,HC SODIUM,301,1 ,$74.00 ,$48.10 ,$4.81 ,$74.00 ,$48.10 ,$4.81 ,$20.72 ,$37.44 ,$4.81 ,$42.55 ,$4.81 ,$37.44 ,$4.81 ,$9.14 ,$60.68 ,$12.03 ,$4.81 ,$62.90 ,$66.60 ,$4.81 ,$55.50 ,$51.80 ,$54.76 ,$54.76 ,$12.03 ,$62.90 ,$4.81 ,$4.81 ,$51.87 ,$4.81 ,$30.78 , N/A ,$62.90 ,$10.34 ,$20.72 ,$66.60 ,$9.62 ,$4.81 ,$48.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100724,84300,HC SODIUM URINE,301,1 ,$70.00 ,$45.50 ,$5.06 ,$70.00 ,$45.50 ,$5.06 ,$19.60 ,$35.42 ,$5.06 ,$40.25 ,$5.06 ,$35.41 ,$5.06 ,$9.61 ,$57.40 ,$12.65 ,$5.06 ,$59.50 ,$63.00 ,$5.06 ,$52.50 ,$49.00 ,$51.80 ,$51.80 ,$12.65 ,$59.50 ,$5.06 ,$5.06 ,$49.07 ,$5.06 ,$29.12 , N/A ,$59.50 ,$10.88 ,$19.60 ,$63.00 ,$10.12 ,$5.06 ,$45.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100740,84439,HC T4 FREE,301,1 ,$172.00 ,$111.80 ,$9.02 ,$172.00 ,$111.80 ,$9.02 ,$48.16 ,$87.03 ,$9.02 ,$98.90 ,$9.02 ,$87.01 ,$9.02 ,$17.14 ,$141.04 ,$22.55 ,$9.02 ,$146.20 ,$154.80 ,$9.02 ,$129.00 ,$120.40 ,$127.28 ,$127.28 ,$22.55 ,$146.20 ,$9.02 ,$9.02 ,$120.57 ,$9.02 ,$71.55 , N/A ,$146.20 ,$19.39 ,$48.16 ,$154.80 ,$18.04 ,$9.02 ,$111.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$192.00 ,$124.80 ,$16.80 ,$192.00 ,$124.80 ,$16.80 ,$53.76 ,$97.15 ,$16.80 ,$110.40 ,$16.80 ,$97.13 ,$16.80 ,$31.92 ,$157.44 ,$42.00 ,$16.80 ,$163.20 ,$172.80 ,$16.80 ,$144.00 ,$134.40 ,$142.08 ,$142.08 ,$42.00 ,$163.20 ,$16.80 ,$16.80 ,$134.59 ,$16.80 ,$79.87 , N/A ,$163.20 ,$36.12 ,$53.76 ,$172.80 ,$33.60 ,$16.80 ,$124.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100746,84450,HC AST,301,1 ,$105.00 ,$68.25 ,$5.18 ,$105.00 ,$68.25 ,$5.18 ,$29.40 ,$53.13 ,$5.18 ,$60.38 ,$5.18 ,$53.12 ,$5.18 ,$9.84 ,$86.10 ,$12.95 ,$5.18 ,$89.25 ,$94.50 ,$5.18 ,$78.75 ,$73.50 ,$77.70 ,$77.70 ,$12.95 ,$89.25 ,$5.18 ,$5.18 ,$73.61 ,$5.18 ,$43.68 , N/A ,$89.25 ,$11.14 ,$29.40 ,$94.50 ,$10.36 ,$5.18 ,$68.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100747,84460,HC ALT,301,1 ,$97.00 ,$63.05 ,$5.30 ,$97.00 ,$63.05 ,$5.30 ,$27.16 ,$49.08 ,$5.30 ,$55.78 ,$5.30 ,$49.07 ,$5.30 ,$10.07 ,$79.54 ,$13.25 ,$5.30 ,$82.45 ,$87.30 ,$5.30 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$13.25 ,$82.45 ,$5.30 ,$5.30 ,$68.00 ,$5.30 ,$40.35 , N/A ,$82.45 ,$11.40 ,$27.16 ,$87.30 ,$10.60 ,$5.30 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100750,84478,HC TRIGLYCERIDES,301,1 ,$113.00 ,$73.45 ,$5.74 ,$113.00 ,$73.45 ,$5.74 ,$31.64 ,$57.18 ,$5.74 ,$64.98 ,$5.74 ,$57.17 ,$5.74 ,$10.91 ,$92.66 ,$14.35 ,$5.74 ,$96.05 ,$101.70 ,$5.74 ,$84.75 ,$79.10 ,$83.62 ,$83.62 ,$14.35 ,$96.05 ,$5.74 ,$5.74 ,$79.21 ,$5.74 ,$47.01 , N/A ,$96.05 ,$12.34 ,$31.64 ,$101.70 ,$11.48 ,$5.74 ,$73.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100758,84484,HC TROPONIN QN,301,1 ,$222.00 ,$144.30 ,$12.47 ,$222.00 ,$144.30 ,$12.47 ,$62.16 ,$112.33 ,$12.47 ,$127.65 ,$12.47 ,$112.31 ,$12.47 ,$23.69 ,$182.04 ,$31.18 ,$12.47 ,$188.70 ,$199.80 ,$12.47 ,$166.50 ,$155.40 ,$164.28 ,$164.28 ,$31.18 ,$188.70 ,$12.47 ,$12.47 ,$155.62 ,$12.47 ,$92.35 , N/A ,$188.70 ,$26.81 ,$62.16 ,$199.80 ,$24.94 ,$12.47 ,$144.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100761,84520,HC BUN,301,1 ,$72.00 ,$46.80 ,$3.95 ,$72.00 ,$46.80 ,$3.95 ,$20.16 ,$36.43 ,$3.95 ,$41.40 ,$3.95 ,$36.42 ,$3.95 ,$7.51 ,$59.04 ,$9.88 ,$3.95 ,$61.20 ,$64.80 ,$3.95 ,$54.00 ,$50.40 ,$53.28 ,$53.28 ,$9.88 ,$61.20 ,$3.95 ,$3.95 ,$50.47 ,$3.95 ,$29.95 , N/A ,$61.20 ,$8.49 ,$20.16 ,$64.80 ,$7.90 ,$3.95 ,$46.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100765,84550,HC URIC ACID,301,1 ,$93.00 ,$60.45 ,$4.52 ,$93.00 ,$60.45 ,$4.52 ,$26.04 ,$47.06 ,$4.52 ,$53.48 ,$4.52 ,$47.05 ,$4.52 ,$8.59 ,$76.26 ,$11.30 ,$4.52 ,$79.05 ,$83.70 ,$4.52 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$11.30 ,$79.05 ,$4.52 ,$4.52 ,$65.19 ,$4.52 ,$38.69 , N/A ,$79.05 ,$9.72 ,$26.04 ,$83.70 ,$9.04 ,$4.52 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100802,84702,HC HCG QN,301,1 ,$223.00 ,$144.95 ,$15.05 ,$223.00 ,$144.95 ,$15.05 ,$62.44 ,$112.84 ,$15.05 ,$128.23 ,$15.05 ,$112.82 ,$15.05 ,$28.60 ,$182.86 ,$37.63 ,$15.05 ,$189.55 ,$200.70 ,$15.05 ,$167.25 ,$156.10 ,$165.02 ,$165.02 ,$37.63 ,$189.55 ,$15.05 ,$15.05 ,$156.32 ,$15.05 ,$92.77 , N/A ,$189.55 ,$32.36 ,$62.44 ,$200.70 ,$30.10 ,$15.05 ,$144.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100808,84703,HC HCG QL,301,1 ,$143.00 ,$92.95 ,$7.52 ,$143.00 ,$92.95 ,$7.52 ,$40.04 ,$72.36 ,$7.52 ,$82.23 ,$7.52 ,$72.34 ,$7.52 ,$14.29 ,$117.26 ,$18.80 ,$7.52 ,$121.55 ,$128.70 ,$7.52 ,$107.25 ,$100.10 ,$105.82 ,$105.82 ,$18.80 ,$121.55 ,$7.52 ,$7.52 ,$100.24 ,$7.52 ,$59.49 , N/A ,$121.55 ,$16.17 ,$40.04 ,$128.70 ,$15.04 ,$7.52 ,$92.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$39.00 ,$25.35 ,$5.04 ,$39.00 ,$25.35 ,$5.04 ,$10.92 ,$19.73 ,$5.04 ,$22.43 ,$5.04 ,$19.73 ,$5.04 ,$9.58 ,$31.98 ,$12.60 ,$5.04 ,$33.15 ,$35.10 ,$5.04 ,$29.25 ,$27.30 ,$28.86 ,$28.86 ,$12.60 ,$33.15 ,$5.04 ,$5.04 ,$27.34 ,$5.04 ,$16.22 , N/A ,$33.15 ,$10.84 ,$10.92 ,$35.10 ,$10.08 ,$5.04 ,$25.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101011,83630,HC LACTOFERRIN FECAL QL,301,1 ,$59.00 ,$38.35 ,$16.52 ,$59.00 ,$38.35 ,$19.70 ,$16.52 ,$29.85 ,$19.70 ,$33.93 ,$19.70 ,$29.85 ,$19.70 ,$37.43 ,$48.38 ,$49.25 ,$19.70 ,$50.15 ,$53.10 ,$19.70 ,$44.25 ,$41.30 ,$43.66 ,$43.66 ,$49.25 ,$50.15 ,$19.70 ,$19.70 ,$41.36 ,$19.70 ,$24.54 , N/A ,$50.15 ,$42.36 ,$16.52 ,$53.10 ,$39.40 ,$19.70 ,$38.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$223.00 ,$144.95 ,$19.31 ,$223.00 ,$144.95 ,$19.31 ,$62.44 ,$112.84 ,$19.31 ,$128.23 ,$19.31 ,$112.82 ,$19.31 ,$36.69 ,$182.86 ,$48.28 ,$19.31 ,$189.55 ,$200.70 ,$19.31 ,$167.25 ,$156.10 ,$165.02 ,$165.02 ,$48.28 ,$189.55 ,$19.31 ,$19.31 ,$156.32 ,$19.31 ,$92.77 , N/A ,$189.55 ,$41.52 ,$62.44 ,$200.70 ,$38.62 ,$19.31 ,$144.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101075,80048,HC BASIC METABOLIC PANEL,301,1 ,$275.00 ,$178.75 ,$8.46 ,$275.00 ,$178.75 ,$8.46 ,$77.00 ,$139.15 ,$8.46 ,$158.13 ,$8.46 ,$139.12 ,$8.46 ,$16.07 ,$225.50 ,$21.15 ,$8.46 ,$233.75 ,$247.50 ,$8.46 ,$206.25 ,$192.50 ,$203.50 ,$203.50 ,$21.15 ,$233.75 ,$8.46 ,$8.46 ,$192.78 ,$8.46 ,$114.40 , N/A ,$233.75 ,$18.19 ,$77.00 ,$247.50 ,$16.92 ,$8.46 ,$178.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101078,80051,HC ELECTROLYTE PANEL,301,1 ,$208.00 ,$135.20 ,$7.01 ,$208.00 ,$135.20 ,$7.01 ,$58.24 ,$105.25 ,$7.01 ,$119.60 ,$7.01 ,$105.23 ,$7.01 ,$13.32 ,$170.56 ,$17.53 ,$7.01 ,$176.80 ,$187.20 ,$7.01 ,$156.00 ,$145.60 ,$153.92 ,$153.92 ,$17.53 ,$176.80 ,$7.01 ,$7.01 ,$145.81 ,$7.01 ,$86.53 , N/A ,$176.80 ,$15.07 ,$58.24 ,$187.20 ,$14.02 ,$7.01 ,$135.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101080,80053,HC COMPREHENSIVE METABOLIC PANEL,301,1 ,$350.00 ,$227.50 ,$10.56 ,$350.00 ,$227.50 ,$10.56 ,$98.00 ,$177.10 ,$10.56 ,$201.25 ,$10.56 ,$177.07 ,$10.56 ,$20.06 ,$287.00 ,$26.40 ,$10.56 ,$297.50 ,$315.00 ,$10.56 ,$262.50 ,$245.00 ,$259.00 ,$259.00 ,$26.40 ,$297.50 ,$10.56 ,$10.56 ,$245.35 ,$10.56 ,$145.60 , N/A ,$297.50 ,$22.70 ,$98.00 ,$315.00 ,$21.12 ,$10.56 ,$227.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101082,80061,HC LIPID PANEL,301,1 ,$275.00 ,$178.75 ,$13.39 ,$275.00 ,$178.75 ,$13.39 ,$77.00 ,$139.15 ,$13.39 ,$158.13 ,$13.39 ,$139.12 ,$13.39 ,$25.44 ,$225.50 ,$33.48 ,$13.39 ,$233.75 ,$247.50 ,$13.39 ,$206.25 ,$192.50 ,$203.50 ,$203.50 ,$33.48 ,$233.75 ,$13.39 ,$13.39 ,$192.78 ,$13.39 ,$114.40 , N/A ,$233.75 ,$28.79 ,$77.00 ,$247.50 ,$26.78 ,$13.39 ,$178.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101084,80069,HC RENAL PANEL,301,1 ,$294.00 ,$191.10 ,$8.68 ,$294.00 ,$191.10 ,$8.68 ,$82.32 ,$148.76 ,$8.68 ,$169.05 ,$8.68 ,$148.73 ,$8.68 ,$16.49 ,$241.08 ,$21.70 ,$8.68 ,$249.90 ,$264.60 ,$8.68 ,$220.50 ,$205.80 ,$217.56 ,$217.56 ,$21.70 ,$249.90 ,$8.68 ,$8.68 ,$206.09 ,$8.68 ,$122.30 , N/A ,$249.90 ,$18.66 ,$82.32 ,$264.60 ,$17.36 ,$8.68 ,$191.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101088,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$298.00 ,$193.70 ,$8.17 ,$298.00 ,$193.70 ,$8.17 ,$83.44 ,$150.79 ,$8.17 ,$171.35 ,$8.17 ,$150.76 ,$8.17 ,$15.52 ,$244.36 ,$20.43 ,$8.17 ,$253.30 ,$268.20 ,$8.17 ,$223.50 ,$208.60 ,$220.52 ,$220.52 ,$20.43 ,$253.30 ,$8.17 ,$8.17 ,$208.90 ,$8.17 ,$123.97 , N/A ,$253.30 ,$17.57 ,$83.44 ,$268.20 ,$16.34 ,$8.17 ,$193.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101089,80150,HC AMIKACIN - 90,301,1 ,$96.00 ,$62.40 ,$15.08 ,$96.00 ,$62.40 ,$15.08 ,$26.88 ,$48.58 ,$15.08 ,$55.20 ,$15.08 ,$48.57 ,$15.08 ,$28.65 ,$78.72 ,$37.70 ,$15.08 ,$81.60 ,$86.40 ,$15.08 ,$72.00 ,$67.20 ,$71.04 ,$71.04 ,$37.70 ,$81.60 ,$15.08 ,$15.08 ,$67.30 ,$15.08 ,$39.94 , N/A ,$81.60 ,$32.42 ,$26.88 ,$86.40 ,$30.16 ,$15.08 ,$62.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101091,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$216.00 ,$140.40 ,$14.57 ,$216.00 ,$140.40 ,$14.57 ,$60.48 ,$109.30 ,$14.57 ,$124.20 ,$14.57 ,$109.27 ,$14.57 ,$27.68 ,$177.12 ,$36.43 ,$14.57 ,$183.60 ,$194.40 ,$14.57 ,$162.00 ,$151.20 ,$159.84 ,$159.84 ,$36.43 ,$183.60 ,$14.57 ,$14.57 ,$151.42 ,$14.57 ,$89.86 , N/A ,$183.60 ,$31.33 ,$60.48 ,$194.40 ,$29.14 ,$14.57 ,$140.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101093,80157,HC CARBAMAZEPINE FREE - 90,301,1 ,$90.00 ,$58.50 ,$13.25 ,$90.00 ,$58.50 ,$13.25 ,$25.20 ,$45.54 ,$13.25 ,$51.75 ,$13.25 ,$45.53 ,$13.25 ,$25.18 ,$73.80 ,$33.13 ,$13.25 ,$76.50 ,$81.00 ,$13.25 ,$67.50 ,$63.00 ,$66.60 ,$66.60 ,$33.13 ,$76.50 ,$13.25 ,$13.25 ,$63.09 ,$13.25 ,$37.44 , N/A ,$76.50 ,$28.49 ,$25.20 ,$81.00 ,$26.50 ,$13.25 ,$58.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101094,80158,HC CYCLOSPORINE - 90,301,1 ,$235.00 ,$152.75 ,$18.05 ,$235.00 ,$152.75 ,$18.05 ,$65.80 ,$118.91 ,$18.05 ,$135.13 ,$18.05 ,$118.89 ,$18.05 ,$34.30 ,$192.70 ,$45.13 ,$18.05 ,$199.75 ,$211.50 ,$18.05 ,$176.25 ,$164.50 ,$173.90 ,$173.90 ,$45.13 ,$199.75 ,$18.05 ,$18.05 ,$164.74 ,$18.05 ,$97.76 , N/A ,$199.75 ,$38.81 ,$65.80 ,$211.50 ,$36.10 ,$18.05 ,$152.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101096,80162,HC DIGOXIN LEVELS,301,1 ,$159.00 ,$103.35 ,$13.28 ,$159.00 ,$103.35 ,$13.28 ,$44.52 ,$80.45 ,$13.28 ,$91.43 ,$13.28 ,$80.44 ,$13.28 ,$25.23 ,$130.38 ,$33.20 ,$13.28 ,$135.15 ,$143.10 ,$13.28 ,$119.25 ,$111.30 ,$117.66 ,$117.66 ,$33.20 ,$135.15 ,$13.28 ,$13.28 ,$111.46 ,$13.28 ,$66.14 , N/A ,$135.15 ,$28.55 ,$44.52 ,$143.10 ,$26.56 ,$13.28 ,$103.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101099,80168,HC ETHOSUXIMIDE - 90,301,1 ,$58.00 ,$37.70 ,$16.24 ,$58.00 ,$37.70 ,$16.34 ,$16.24 ,$29.35 ,$16.34 ,$33.35 ,$16.34 ,$29.34 ,$16.34 ,$31.05 ,$47.56 ,$40.85 ,$16.34 ,$49.30 ,$52.20 ,$16.34 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$40.85 ,$49.30 ,$16.34 ,$16.34 ,$40.66 ,$16.34 ,$24.13 , N/A ,$49.30 ,$35.13 ,$16.24 ,$52.20 ,$32.68 ,$16.34 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101100,80169,HC EVEROLIMUS - 90,301,1 ,$247.00 ,$160.55 ,$13.73 ,$247.00 ,$160.55 ,$13.73 ,$69.16 ,$124.98 ,$13.73 ,$142.03 ,$13.73 ,$124.96 ,$13.73 ,$26.09 ,$202.54 ,$34.33 ,$13.73 ,$209.95 ,$222.30 ,$13.73 ,$185.25 ,$172.90 ,$182.78 ,$182.78 ,$34.33 ,$209.95 ,$13.73 ,$13.73 ,$173.15 ,$13.73 ,$102.75 , N/A ,$209.95 ,$29.52 ,$69.16 ,$222.30 ,$27.46 ,$13.73 ,$160.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101102,80171,HC GABAPENTIN PLASMA - 90,301,1 ,$148.00 ,$96.20 ,$21.67 ,$148.00 ,$96.20 ,$21.67 ,$41.44 ,$74.89 ,$21.67 ,$85.10 ,$21.67 ,$74.87 ,$21.67 ,$41.17 ,$121.36 ,$54.18 ,$21.67 ,$125.80 ,$133.20 ,$21.67 ,$111.00 ,$103.60 ,$109.52 ,$109.52 ,$54.18 ,$125.80 ,$21.67 ,$21.67 ,$103.75 ,$21.67 ,$61.57 , N/A ,$125.80 ,$46.59 ,$41.44 ,$133.20 ,$43.34 ,$21.67 ,$96.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101104,80175,HC LAMOTRIGINE - 90,301,1 ,$151.00 ,$98.15 ,$13.25 ,$151.00 ,$98.15 ,$13.25 ,$42.28 ,$76.41 ,$13.25 ,$86.83 ,$13.25 ,$76.39 ,$13.25 ,$25.18 ,$123.82 ,$33.13 ,$13.25 ,$128.35 ,$135.90 ,$13.25 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$33.13 ,$128.35 ,$13.25 ,$13.25 ,$105.85 ,$13.25 ,$62.82 , N/A ,$128.35 ,$28.49 ,$42.28 ,$135.90 ,$26.50 ,$13.25 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101106,80177,HC LEVETIRACETAM - 90,301,1 ,$151.00 ,$98.15 ,$13.25 ,$151.00 ,$98.15 ,$13.25 ,$42.28 ,$76.41 ,$13.25 ,$86.83 ,$13.25 ,$76.39 ,$13.25 ,$25.18 ,$123.82 ,$33.13 ,$13.25 ,$128.35 ,$135.90 ,$13.25 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$33.13 ,$128.35 ,$13.25 ,$13.25 ,$105.85 ,$13.25 ,$62.82 , N/A ,$128.35 ,$28.49 ,$42.28 ,$135.90 ,$26.50 ,$13.25 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101107,80178,HC LITHIUM,301,1 ,$91.00 ,$59.15 ,$6.61 ,$91.00 ,$59.15 ,$6.61 ,$25.48 ,$46.05 ,$6.61 ,$52.33 ,$6.61 ,$46.04 ,$6.61 ,$12.56 ,$74.62 ,$16.53 ,$6.61 ,$77.35 ,$81.90 ,$6.61 ,$68.25 ,$63.70 ,$67.34 ,$67.34 ,$16.53 ,$77.35 ,$6.61 ,$6.61 ,$63.79 ,$6.61 ,$37.86 , N/A ,$77.35 ,$14.21 ,$25.48 ,$81.90 ,$13.22 ,$6.61 ,$59.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101109,80183,HC OXCARBAZEPINE - 90,301,1 ,$215.00 ,$139.75 ,$13.25 ,$215.00 ,$139.75 ,$13.25 ,$60.20 ,$108.79 ,$13.25 ,$123.63 ,$13.25 ,$108.77 ,$13.25 ,$25.18 ,$176.30 ,$33.13 ,$13.25 ,$182.75 ,$193.50 ,$13.25 ,$161.25 ,$150.50 ,$159.10 ,$159.10 ,$33.13 ,$182.75 ,$13.25 ,$13.25 ,$150.72 ,$13.25 ,$89.44 , N/A ,$182.75 ,$28.49 ,$60.20 ,$193.50 ,$26.50 ,$13.25 ,$139.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101112,80185,HC PHENYTOIN TOTAL,301,1 ,$180.00 ,$117.00 ,$13.25 ,$180.00 ,$117.00 ,$13.25 ,$50.40 ,$91.08 ,$13.25 ,$103.50 ,$13.25 ,$91.06 ,$13.25 ,$25.18 ,$147.60 ,$33.13 ,$13.25 ,$153.00 ,$162.00 ,$13.25 ,$135.00 ,$126.00 ,$133.20 ,$133.20 ,$33.13 ,$153.00 ,$13.25 ,$13.25 ,$126.18 ,$13.25 ,$74.88 , N/A ,$153.00 ,$28.49 ,$50.40 ,$162.00 ,$26.50 ,$13.25 ,$117.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101114,80186,HC PHENYTOIN FREE - 90,301,1 ,$58.00 ,$37.70 ,$13.76 ,$58.00 ,$37.70 ,$13.76 ,$16.24 ,$29.35 ,$13.76 ,$33.35 ,$13.76 ,$29.34 ,$13.76 ,$26.14 ,$47.56 ,$34.40 ,$13.76 ,$49.30 ,$52.20 ,$13.76 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$34.40 ,$49.30 ,$13.76 ,$13.76 ,$40.66 ,$13.76 ,$24.13 , N/A ,$49.30 ,$29.58 ,$16.24 ,$52.20 ,$27.52 ,$13.76 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101115,80188,HC PRIMIDONE - 90,301,1 ,$64.00 ,$41.60 ,$16.59 ,$64.00 ,$41.60 ,$16.59 ,$17.92 ,$32.38 ,$16.59 ,$36.80 ,$16.59 ,$32.38 ,$16.59 ,$31.52 ,$52.48 ,$41.48 ,$16.59 ,$54.40 ,$57.60 ,$16.59 ,$48.00 ,$44.80 ,$47.36 ,$47.36 ,$41.48 ,$54.40 ,$16.59 ,$16.59 ,$44.86 ,$16.59 ,$26.62 , N/A ,$54.40 ,$35.67 ,$17.92 ,$57.60 ,$33.18 ,$16.59 ,$41.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101116,80192,HC PROCAINEAMIDE - 90,301,1 ,$59.00 ,$38.35 ,$16.52 ,$59.00 ,$38.35 ,$16.75 ,$16.52 ,$29.85 ,$16.75 ,$33.93 ,$16.75 ,$29.85 ,$16.75 ,$31.83 ,$48.38 ,$41.88 ,$16.75 ,$50.15 ,$53.10 ,$16.75 ,$44.25 ,$41.30 ,$43.66 ,$43.66 ,$41.88 ,$50.15 ,$16.75 ,$16.75 ,$41.36 ,$16.75 ,$24.54 , N/A ,$50.15 ,$36.01 ,$16.52 ,$53.10 ,$33.50 ,$16.75 ,$38.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101118,80195,HC RAPAMYCIN (SIROLIMUS) - 90,301,1 ,$90.00 ,$58.50 ,$13.73 ,$90.00 ,$58.50 ,$13.73 ,$25.20 ,$45.54 ,$13.73 ,$51.75 ,$13.73 ,$45.53 ,$13.73 ,$26.09 ,$73.80 ,$34.33 ,$13.73 ,$76.50 ,$81.00 ,$13.73 ,$67.50 ,$63.00 ,$66.60 ,$66.60 ,$34.33 ,$76.50 ,$13.73 ,$13.73 ,$63.09 ,$13.73 ,$37.44 , N/A ,$76.50 ,$29.52 ,$25.20 ,$81.00 ,$27.46 ,$13.73 ,$58.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101119,80197,HC TACROLIMUS - 90,301,1 ,$428.00 ,$278.20 ,$13.73 ,$428.00 ,$278.20 ,$13.73 ,$119.84 ,$216.57 ,$13.73 ,$246.10 ,$13.73 ,$216.53 ,$13.73 ,$26.09 ,$350.96 ,$34.33 ,$13.73 ,$363.80 ,$385.20 ,$13.73 ,$321.00 ,$299.60 ,$316.72 ,$316.72 ,$34.33 ,$363.80 ,$13.73 ,$13.73 ,$300.03 ,$13.73 ,$178.05 , N/A ,$363.80 ,$29.52 ,$119.84 ,$385.20 ,$27.46 ,$13.73 ,$278.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101124,80201,HC TOPIRAMATE - 90,301,1 ,$179.00 ,$116.35 ,$11.92 ,$179.00 ,$116.35 ,$11.92 ,$50.12 ,$90.57 ,$11.92 ,$102.93 ,$11.92 ,$90.56 ,$11.92 ,$22.65 ,$146.78 ,$29.80 ,$11.92 ,$152.15 ,$161.10 ,$11.92 ,$134.25 ,$125.30 ,$132.46 ,$132.46 ,$29.80 ,$152.15 ,$11.92 ,$11.92 ,$125.48 ,$11.92 ,$74.46 , N/A ,$152.15 ,$25.63 ,$50.12 ,$161.10 ,$23.84 ,$11.92 ,$116.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101125,80202,HC VANCOMYCIN,301,1 ,$199.00 ,$129.35 ,$13.54 ,$199.00 ,$129.35 ,$13.54 ,$55.72 ,$100.69 ,$13.54 ,$114.43 ,$13.54 ,$100.67 ,$13.54 ,$25.73 ,$163.18 ,$33.85 ,$13.54 ,$169.15 ,$179.10 ,$13.54 ,$149.25 ,$139.30 ,$147.26 ,$147.26 ,$33.85 ,$169.15 ,$13.54 ,$13.54 ,$139.50 ,$13.54 ,$82.78 , N/A ,$169.15 ,$29.11 ,$55.72 ,$179.10 ,$27.08 ,$13.54 ,$129.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101126,80203,HC ZONISAMIDE - 90,301,1 ,$131.00 ,$85.15 ,$13.25 ,$131.00 ,$85.15 ,$13.25 ,$36.68 ,$66.29 ,$13.25 ,$75.33 ,$13.25 ,$66.27 ,$13.25 ,$25.18 ,$107.42 ,$33.13 ,$13.25 ,$111.35 ,$117.90 ,$13.25 ,$98.25 ,$91.70 ,$96.94 ,$96.94 ,$33.13 ,$111.35 ,$13.25 ,$13.25 ,$91.83 ,$13.25 ,$54.50 , N/A ,$111.35 ,$28.49 ,$36.68 ,$117.90 ,$26.50 ,$13.25 ,$85.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101131,80299,HC THERAPEUTIC DRUG OTHER - 90,301,1 ,$156.00 ,$101.40 ,$18.64 ,$156.00 ,$101.40 ,$18.64 ,$43.68 ,$78.94 ,$18.64 ,$89.70 ,$18.64 ,$78.92 ,$18.64 ,$35.42 ,$127.92 ,$46.60 ,$18.64 ,$132.60 ,$140.40 ,$18.64 ,$117.00 ,$109.20 ,$115.44 ,$115.44 ,$46.60 ,$132.60 ,$18.64 ,$18.64 ,$109.36 ,$18.64 ,$64.90 , N/A ,$132.60 ,$40.08 ,$43.68 ,$140.40 ,$37.28 ,$18.64 ,$101.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101137,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4,301,1 ,$192.00 ,$124.80 ,$53.76 ,$192.00 ,$124.80 ,$62.14 ,$53.76 ,$97.15 ,$62.14 ,$110.40 ,$62.14 ,$97.13 ,$62.14 ,$118.07 ,$157.44 ,$155.35 ,$62.14 ,$163.20 ,$172.80 ,$62.14 ,$144.00 ,$134.40 ,$142.08 ,$142.08 ,$155.35 ,$163.20 ,$62.14 ,$62.14 ,$134.59 ,$62.14 ,$79.87 , N/A ,$163.20 ,$133.60 ,$53.76 ,$172.80 ,$124.28 ,$62.14 ,$124.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101140,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1-90,301,1 ,$186.00 ,$120.90 ,$52.08 ,$186.00 ,$120.90 ,$62.14 ,$52.08 ,$94.12 ,$62.14 ,$106.95 ,$62.14 ,$94.10 ,$62.14 ,$118.07 ,$152.52 ,$155.35 ,$62.14 ,$158.10 ,$167.40 ,$62.14 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$155.35 ,$158.10 ,$62.14 ,$62.14 ,$130.39 ,$62.14 ,$77.38 , N/A ,$158.10 ,$133.60 ,$52.08 ,$167.40 ,$124.28 ,$62.14 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101143,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4-90,301,1 ,$340.00 ,$221.00 ,$62.14 ,$340.00 ,$221.00 ,$62.14 ,$95.20 ,$172.04 ,$62.14 ,$195.50 ,$62.14 ,$172.01 ,$62.14 ,$118.07 ,$278.80 ,$155.35 ,$62.14 ,$289.00 ,$306.00 ,$62.14 ,$255.00 ,$238.00 ,$251.60 ,$251.60 ,$155.35 ,$289.00 ,$62.14 ,$62.14 ,$238.34 ,$62.14 ,$141.44 , N/A ,$289.00 ,$133.60 ,$95.20 ,$306.00 ,$124.28 ,$62.14 ,$221.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101146,80323,HC NICOTINE - 90,301,1 ,$388.00 ,$252.20 ,$108.64 ,$388.00 ,$252.20 , N/A ,$108.64 ,$196.33 , N/A ,$223.10 , N/A ,$196.29 , N/A , N/A ,$318.16 , N/A , N/A ,$329.80 ,$349.20 , N/A ,$291.00 ,$271.60 ,$287.12 ,$287.12 , N/A ,$329.80 , N/A , N/A ,$271.99 , N/A ,$161.41 , N/A ,$329.80 , N/A ,$108.64 ,$349.20 , N/A , N/A ,$252.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101147,80323,HC NICOTINE URINE - 90,301,1 ,$388.00 ,$252.20 ,$108.64 ,$388.00 ,$252.20 , N/A ,$108.64 ,$196.33 , N/A ,$223.10 , N/A ,$196.29 , N/A , N/A ,$318.16 , N/A , N/A ,$329.80 ,$349.20 , N/A ,$291.00 ,$271.60 ,$287.12 ,$287.12 , N/A ,$329.80 , N/A , N/A ,$271.99 , N/A ,$161.41 , N/A ,$329.80 , N/A ,$108.64 ,$349.20 , N/A , N/A ,$252.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101158,82024,HC ACTH -90,301,1 ,$292.00 ,$189.80 ,$38.62 ,$292.00 ,$189.80 ,$38.62 ,$81.76 ,$147.75 ,$38.62 ,$167.90 ,$38.62 ,$147.72 ,$38.62 ,$73.38 ,$239.44 ,$96.55 ,$38.62 ,$248.20 ,$262.80 ,$38.62 ,$219.00 ,$204.40 ,$216.08 ,$216.08 ,$96.55 ,$248.20 ,$38.62 ,$38.62 ,$204.69 ,$38.62 ,$121.47 , N/A ,$248.20 ,$83.03 ,$81.76 ,$262.80 ,$77.24 ,$38.62 ,$189.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101159,82040,HC ALBUMIN-90,301,1 ,$76.00 ,$49.40 ,$4.95 ,$76.00 ,$49.40 ,$4.95 ,$21.28 ,$38.46 ,$4.95 ,$43.70 ,$4.95 ,$38.45 ,$4.95 ,$9.41 ,$62.32 ,$12.38 ,$4.95 ,$64.60 ,$68.40 ,$4.95 ,$57.00 ,$53.20 ,$56.24 ,$56.24 ,$12.38 ,$64.60 ,$4.95 ,$4.95 ,$53.28 ,$4.95 ,$31.62 , N/A ,$64.60 ,$10.64 ,$21.28 ,$68.40 ,$9.90 ,$4.95 ,$49.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101160,82042,HC ALBUMIN OTHER SOURCE-90,301,1 ,$33.70 ,$21.91 ,$7.78 ,$33.70 ,$21.91 ,$7.78 ,$9.44 ,$17.05 ,$7.78 ,$19.38 ,$7.78 ,$17.05 ,$7.78 ,$14.78 ,$27.63 ,$19.45 ,$7.78 ,$28.65 ,$30.33 ,$7.78 ,$25.28 ,$23.59 ,$24.94 ,$24.94 ,$19.45 ,$28.65 ,$7.78 ,$7.78 ,$23.62 ,$7.78 ,$14.02 , N/A ,$28.65 ,$16.73 ,$9.44 ,$30.33 ,$15.56 ,$7.78 ,$21.91 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101162,82085,HC ALDOLASE-90,301,1 ,$118.00 ,$76.70 ,$9.71 ,$118.00 ,$76.70 ,$9.71 ,$33.04 ,$59.71 ,$9.71 ,$67.85 ,$9.71 ,$59.70 ,$9.71 ,$18.45 ,$96.76 ,$24.28 ,$9.71 ,$100.30 ,$106.20 ,$9.71 ,$88.50 ,$82.60 ,$87.32 ,$87.32 ,$24.28 ,$100.30 ,$9.71 ,$9.71 ,$82.72 ,$9.71 ,$49.09 , N/A ,$100.30 ,$20.88 ,$33.04 ,$106.20 ,$19.42 ,$9.71 ,$76.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101163,82088,HC ALDOSTERONE-90,301,1 ,$193.00 ,$125.45 ,$40.75 ,$193.00 ,$125.45 ,$40.75 ,$54.04 ,$97.66 ,$40.75 ,$110.98 ,$40.75 ,$97.64 ,$40.75 ,$77.43 ,$158.26 ,$101.88 ,$40.75 ,$164.05 ,$173.70 ,$40.75 ,$144.75 ,$135.10 ,$142.82 ,$142.82 ,$101.88 ,$164.05 ,$40.75 ,$40.75 ,$135.29 ,$40.75 ,$80.29 , N/A ,$164.05 ,$87.61 ,$54.04 ,$173.70 ,$81.50 ,$40.75 ,$125.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101164,82103,HC ALPHA-1 ANTITRYPSIN TOTAL-90,301,1 ,$131.00 ,$85.15 ,$13.44 ,$131.00 ,$85.15 ,$13.44 ,$36.68 ,$66.29 ,$13.44 ,$75.33 ,$13.44 ,$66.27 ,$13.44 ,$25.54 ,$107.42 ,$33.60 ,$13.44 ,$111.35 ,$117.90 ,$13.44 ,$98.25 ,$91.70 ,$96.94 ,$96.94 ,$33.60 ,$111.35 ,$13.44 ,$13.44 ,$91.83 ,$13.44 ,$54.50 , N/A ,$111.35 ,$28.90 ,$36.68 ,$117.90 ,$26.88 ,$13.44 ,$85.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101165,82104,HC ALPHA-1 ANTITRYPSIN PHENO-90,301,1 ,$158.00 ,$102.70 ,$14.46 ,$158.00 ,$102.70 ,$14.46 ,$44.24 ,$79.95 ,$14.46 ,$90.85 ,$14.46 ,$79.93 ,$14.46 ,$27.47 ,$129.56 ,$36.15 ,$14.46 ,$134.30 ,$142.20 ,$14.46 ,$118.50 ,$110.60 ,$116.92 ,$116.92 ,$36.15 ,$134.30 ,$14.46 ,$14.46 ,$110.76 ,$14.46 ,$65.73 , N/A ,$134.30 ,$31.09 ,$44.24 ,$142.20 ,$28.92 ,$14.46 ,$102.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101166,82105,HC ALPHA FETOPROTEIN SERUM-90,301,1 ,$222.00 ,$144.30 ,$16.77 ,$222.00 ,$144.30 ,$16.77 ,$62.16 ,$112.33 ,$16.77 ,$127.65 ,$16.77 ,$112.31 ,$16.77 ,$31.86 ,$182.04 ,$41.93 ,$16.77 ,$188.70 ,$199.80 ,$16.77 ,$166.50 ,$155.40 ,$164.28 ,$164.28 ,$41.93 ,$188.70 ,$16.77 ,$16.77 ,$155.62 ,$16.77 ,$92.35 , N/A ,$188.70 ,$36.06 ,$62.16 ,$199.80 ,$33.54 ,$16.77 ,$144.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101169,82108,HC ALUMINUM-90,301,1 ,$18.00 ,$11.70 ,$5.04 ,$45.00 ,$11.70 ,$18.00 ,$5.04 ,$9.11 ,$18.00 ,$10.35 ,$18.00 ,$9.11 ,$18.00 ,$18.00 ,$14.76 ,$45.00 ,$18.00 ,$15.30 ,$16.20 ,$18.00 ,$13.50 ,$12.60 ,$13.32 ,$13.32 ,$18.00 ,$15.30 ,$18.00 ,$18.00 ,$12.62 ,$18.00 ,$7.49 , N/A ,$15.30 ,$38.70 ,$5.04 ,$16.20 ,$18.00 ,$18.00 ,$11.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101172,82131,HC AMINO ACID QN SINGLE-90,301,1 ,$69.00 ,$44.85 ,$19.32 ,$69.00 ,$44.85 ,$22.98 ,$19.32 ,$34.91 ,$22.98 ,$39.68 ,$22.98 ,$34.91 ,$22.98 ,$43.66 ,$56.58 ,$57.45 ,$22.98 ,$58.65 ,$62.10 ,$22.98 ,$51.75 ,$48.30 ,$51.06 ,$51.06 ,$57.45 ,$58.65 ,$22.98 ,$22.98 ,$48.37 ,$22.98 ,$28.70 , N/A ,$58.65 ,$49.41 ,$19.32 ,$62.10 ,$45.96 ,$22.98 ,$44.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101175,82139,HC AMINO ACIDS 6+ QN CSF-90,301,1 ,$360.00 ,$234.00 ,$16.87 ,$360.00 ,$234.00 ,$16.87 ,$100.80 ,$182.16 ,$16.87 ,$207.00 ,$16.87 ,$182.12 ,$16.87 ,$32.05 ,$295.20 ,$42.18 ,$16.87 ,$306.00 ,$324.00 ,$16.87 ,$270.00 ,$252.00 ,$266.40 ,$266.40 ,$42.18 ,$306.00 ,$16.87 ,$16.87 ,$252.36 ,$16.87 ,$149.76 , N/A ,$306.00 ,$36.27 ,$100.80 ,$324.00 ,$33.74 ,$16.87 ,$234.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101176,82140,HC AMMONIA-90,301,1 ,$209.00 ,$135.85 ,$14.57 ,$209.00 ,$135.85 ,$14.57 ,$58.52 ,$105.75 ,$14.57 ,$120.18 ,$14.57 ,$105.73 ,$14.57 ,$27.68 ,$171.38 ,$36.43 ,$14.57 ,$177.65 ,$188.10 ,$14.57 ,$156.75 ,$146.30 ,$154.66 ,$154.66 ,$36.43 ,$177.65 ,$14.57 ,$14.57 ,$146.51 ,$14.57 ,$86.94 , N/A ,$177.65 ,$31.33 ,$58.52 ,$188.10 ,$29.14 ,$14.57 ,$135.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101177,82150,HC AMYLASE-90,301,1 ,$126.00 ,$81.90 ,$6.48 ,$126.00 ,$81.90 ,$6.48 ,$35.28 ,$63.76 ,$6.48 ,$72.45 ,$6.48 ,$63.74 ,$6.48 ,$12.31 ,$103.32 ,$16.20 ,$6.48 ,$107.10 ,$113.40 ,$6.48 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$16.20 ,$107.10 ,$6.48 ,$6.48 ,$88.33 ,$6.48 ,$52.42 , N/A ,$107.10 ,$13.93 ,$35.28 ,$113.40 ,$12.96 ,$6.48 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101178,82157,HC ANDROSTENEDIONE-90,301,1 ,$110.00 ,$71.50 ,$29.28 ,$110.00 ,$71.50 ,$29.28 ,$30.80 ,$55.66 ,$29.28 ,$63.25 ,$29.28 ,$55.65 ,$29.28 ,$55.63 ,$90.20 ,$73.20 ,$29.28 ,$93.50 ,$99.00 ,$29.28 ,$82.50 ,$77.00 ,$81.40 ,$81.40 ,$73.20 ,$93.50 ,$29.28 ,$29.28 ,$77.11 ,$29.28 ,$45.76 , N/A ,$93.50 ,$62.95 ,$30.80 ,$99.00 ,$58.56 ,$29.28 ,$71.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101179,82164,HC ANGIOTENSIN 1 ENZYME (ACE)-90,301,1 ,$97.00 ,$63.05 ,$14.60 ,$97.00 ,$63.05 ,$14.60 ,$27.16 ,$49.08 ,$14.60 ,$55.78 ,$14.60 ,$49.07 ,$14.60 ,$27.74 ,$79.54 ,$36.50 ,$14.60 ,$82.45 ,$87.30 ,$14.60 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$36.50 ,$82.45 ,$14.60 ,$14.60 ,$68.00 ,$14.60 ,$40.35 , N/A ,$82.45 ,$31.39 ,$27.16 ,$87.30 ,$29.20 ,$14.60 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101180,82172,HC APOLIPOPROTEIN SERUM-90,301,1 ,$58.00 ,$37.70 ,$16.24 ,$58.00 ,$37.70 ,$21.09 ,$16.24 ,$29.35 ,$21.09 ,$33.35 ,$21.09 ,$29.34 ,$21.09 ,$40.07 ,$47.56 ,$52.73 ,$21.09 ,$49.30 ,$52.20 ,$21.09 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$52.73 ,$49.30 ,$21.09 ,$21.09 ,$40.66 ,$21.09 ,$24.13 , N/A ,$49.30 ,$45.34 ,$16.24 ,$52.20 ,$42.18 ,$21.09 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101181,82175,HC ARSENIC-90,301,1 ,$73.00 ,$47.45 ,$18.97 ,$73.00 ,$47.45 ,$18.97 ,$20.44 ,$36.94 ,$18.97 ,$41.98 ,$18.97 ,$36.93 ,$18.97 ,$36.04 ,$59.86 ,$47.43 ,$18.97 ,$62.05 ,$65.70 ,$18.97 ,$54.75 ,$51.10 ,$54.02 ,$54.02 ,$47.43 ,$62.05 ,$18.97 ,$18.97 ,$51.17 ,$18.97 ,$30.37 , N/A ,$62.05 ,$40.79 ,$20.44 ,$65.70 ,$37.94 ,$18.97 ,$47.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101182,82180,HC VITAMIN C (ASCORBIC ACID)-90,301,1 ,$58.00 ,$37.70 ,$9.89 ,$58.00 ,$37.70 ,$9.89 ,$16.24 ,$29.35 ,$9.89 ,$33.35 ,$9.89 ,$29.34 ,$9.89 ,$18.79 ,$47.56 ,$24.73 ,$9.89 ,$49.30 ,$52.20 ,$9.89 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$24.73 ,$49.30 ,$9.89 ,$9.89 ,$40.66 ,$9.89 ,$24.13 , N/A ,$49.30 ,$21.26 ,$16.24 ,$52.20 ,$19.78 ,$9.89 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101184,82232,HC BETA 2 MICROGLOBULIN-90,301,1 ,$111.00 ,$72.15 ,$16.18 ,$111.00 ,$72.15 ,$16.18 ,$31.08 ,$56.17 ,$16.18 ,$63.83 ,$16.18 ,$56.15 ,$16.18 ,$30.74 ,$91.02 ,$40.45 ,$16.18 ,$94.35 ,$99.90 ,$16.18 ,$83.25 ,$77.70 ,$82.14 ,$82.14 ,$40.45 ,$94.35 ,$16.18 ,$16.18 ,$77.81 ,$16.18 ,$46.18 , N/A ,$94.35 ,$34.79 ,$31.08 ,$99.90 ,$32.36 ,$16.18 ,$72.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101191,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$65.00 ,$42.25 ,$5.32 ,$65.00 ,$42.25 ,$5.32 ,$18.20 ,$32.89 ,$5.32 ,$37.38 ,$5.32 ,$32.88 ,$5.32 ,$10.11 ,$53.30 ,$13.30 ,$5.32 ,$55.25 ,$58.50 ,$5.32 ,$48.75 ,$45.50 ,$48.10 ,$48.10 ,$13.30 ,$55.25 ,$5.32 ,$5.32 ,$45.57 ,$5.32 ,$27.04 , N/A ,$55.25 ,$11.44 ,$18.20 ,$58.50 ,$10.64 ,$5.32 ,$42.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101196,82300,HC CADMIUM-90,301,1 ,$67.00 ,$43.55 ,$18.76 ,$67.00 ,$43.55 ,$23.64 ,$18.76 ,$33.90 ,$23.64 ,$38.53 ,$23.64 ,$33.90 ,$23.64 ,$44.92 ,$54.94 ,$59.10 ,$23.64 ,$56.95 ,$60.30 ,$23.64 ,$50.25 ,$46.90 ,$49.58 ,$49.58 ,$59.10 ,$56.95 ,$23.64 ,$23.64 ,$46.97 ,$23.64 ,$27.87 , N/A ,$56.95 ,$50.83 ,$18.76 ,$60.30 ,$47.28 ,$23.64 ,$43.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101199,82308,HC CALCITONIN-90,301,1 ,$79.00 ,$51.35 ,$22.12 ,$79.00 ,$51.35 ,$26.79 ,$22.12 ,$39.97 ,$26.79 ,$45.43 ,$26.79 ,$39.97 ,$26.79 ,$50.90 ,$64.78 ,$66.98 ,$26.79 ,$67.15 ,$71.10 ,$26.79 ,$59.25 ,$55.30 ,$58.46 ,$58.46 ,$66.98 ,$67.15 ,$26.79 ,$26.79 ,$55.38 ,$26.79 ,$32.86 , N/A ,$67.15 ,$57.60 ,$22.12 ,$71.10 ,$53.58 ,$26.79 ,$51.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101203,82340,HC CALCIUM URINE QN TIMED-90,301,1 ,$154.00 ,$100.10 ,$6.03 ,$154.00 ,$100.10 ,$6.03 ,$43.12 ,$77.92 ,$6.03 ,$88.55 ,$6.03 ,$77.91 ,$6.03 ,$11.46 ,$126.28 ,$15.08 ,$6.03 ,$130.90 ,$138.60 ,$6.03 ,$115.50 ,$107.80 ,$113.96 ,$113.96 ,$15.08 ,$130.90 ,$6.03 ,$6.03 ,$107.95 ,$6.03 ,$64.06 , N/A ,$130.90 ,$12.96 ,$43.12 ,$138.60 ,$12.06 ,$6.03 ,$100.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101205,82365,HC CALCULUS ANLYS INFRARED-90,301,1 ,$42.00 ,$27.30 ,$11.76 ,$42.00 ,$27.30 ,$12.90 ,$11.76 ,$21.25 ,$12.90 ,$24.15 ,$12.90 ,$21.25 ,$12.90 ,$24.51 ,$34.44 ,$32.25 ,$12.90 ,$35.70 ,$37.80 ,$12.90 ,$31.50 ,$29.40 ,$31.08 ,$31.08 ,$32.25 ,$35.70 ,$12.90 ,$12.90 ,$29.44 ,$12.90 ,$17.47 , N/A ,$35.70 ,$27.74 ,$11.76 ,$37.80 ,$25.80 ,$12.90 ,$27.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101209,82379,HC CARNITINE TOTAL AND FREE QN-90,301,1 ,$217.00 ,$141.05 ,$16.87 ,$217.00 ,$141.05 ,$16.87 ,$60.76 ,$109.80 ,$16.87 ,$124.78 ,$16.87 ,$109.78 ,$16.87 ,$32.05 ,$177.94 ,$42.18 ,$16.87 ,$184.45 ,$195.30 ,$16.87 ,$162.75 ,$151.90 ,$160.58 ,$160.58 ,$42.18 ,$184.45 ,$16.87 ,$16.87 ,$152.12 ,$16.87 ,$90.27 , N/A ,$184.45 ,$36.27 ,$60.76 ,$195.30 ,$33.74 ,$16.87 ,$141.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101210,82380,HC CAROTENE-90,301,1 ,$58.00 ,$37.70 ,$9.22 ,$58.00 ,$37.70 ,$9.22 ,$16.24 ,$29.35 ,$9.22 ,$33.35 ,$9.22 ,$29.34 ,$9.22 ,$17.52 ,$47.56 ,$23.05 ,$9.22 ,$49.30 ,$52.20 ,$9.22 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$23.05 ,$49.30 ,$9.22 ,$9.22 ,$40.66 ,$9.22 ,$24.13 , N/A ,$49.30 ,$19.82 ,$16.24 ,$52.20 ,$18.44 ,$9.22 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101211,82384,HC CATECHOLAMINE FRACTION-90,301,1 ,$361.00 ,$234.65 ,$25.25 ,$361.00 ,$234.65 ,$25.25 ,$101.08 ,$182.67 ,$25.25 ,$207.58 ,$25.25 ,$182.63 ,$25.25 ,$47.98 ,$296.02 ,$63.13 ,$25.25 ,$306.85 ,$324.90 ,$25.25 ,$270.75 ,$252.70 ,$267.14 ,$267.14 ,$63.13 ,$306.85 ,$25.25 ,$25.25 ,$253.06 ,$25.25 ,$150.18 , N/A ,$306.85 ,$54.29 ,$101.08 ,$324.90 ,$50.50 ,$25.25 ,$234.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101212,82390,HC CERULOPLASMIN-90,301,1 ,$99.00 ,$64.35 ,$10.74 ,$99.00 ,$64.35 ,$10.74 ,$27.72 ,$50.09 ,$10.74 ,$56.93 ,$10.74 ,$50.08 ,$10.74 ,$20.41 ,$81.18 ,$26.85 ,$10.74 ,$84.15 ,$89.10 ,$10.74 ,$74.25 ,$69.30 ,$73.26 ,$73.26 ,$26.85 ,$84.15 ,$10.74 ,$10.74 ,$69.40 ,$10.74 ,$41.18 , N/A ,$84.15 ,$23.09 ,$27.72 ,$89.10 ,$21.48 ,$10.74 ,$64.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101213,82397,HC CHEMILUMINESCENT ASSAY-90,301,1 ,$154.00 ,$100.10 ,$14.12 ,$154.00 ,$100.10 ,$14.12 ,$43.12 ,$77.92 ,$14.12 ,$88.55 ,$14.12 ,$77.91 ,$14.12 ,$26.83 ,$126.28 ,$35.30 ,$14.12 ,$130.90 ,$138.60 ,$14.12 ,$115.50 ,$107.80 ,$113.96 ,$113.96 ,$35.30 ,$130.90 ,$14.12 ,$14.12 ,$107.95 ,$14.12 ,$64.06 , N/A ,$130.90 ,$30.36 ,$43.12 ,$138.60 ,$28.24 ,$14.12 ,$100.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101215,82438,HC CHLORIDE OTHER SOURCE-90,301,1 ,$25.10 ,$16.32 ,$5.00 ,$25.10 ,$16.32 ,$5.00 ,$7.03 ,$12.70 ,$5.00 ,$14.43 ,$5.00 ,$12.70 ,$5.00 ,$9.50 ,$20.58 ,$12.50 ,$5.00 ,$21.34 ,$22.59 ,$5.00 ,$18.83 ,$17.57 ,$18.57 ,$18.57 ,$12.50 ,$21.34 ,$5.00 ,$5.00 ,$17.60 ,$5.00 ,$10.44 , N/A ,$21.34 ,$10.75 ,$7.03 ,$22.59 ,$10.00 ,$5.00 ,$16.32 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101216,82480,HC CHOLINESTERASE PSEUDO-90,301,1 ,$70.00 ,$45.50 ,$7.87 ,$70.00 ,$45.50 ,$7.87 ,$19.60 ,$35.42 ,$7.87 ,$40.25 ,$7.87 ,$35.41 ,$7.87 ,$14.95 ,$57.40 ,$19.68 ,$7.87 ,$59.50 ,$63.00 ,$7.87 ,$52.50 ,$49.00 ,$51.80 ,$51.80 ,$19.68 ,$59.50 ,$7.87 ,$7.87 ,$49.07 ,$7.87 ,$29.12 , N/A ,$59.50 ,$16.92 ,$19.60 ,$63.00 ,$15.74 ,$7.87 ,$45.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101218,82495,HC CHROMIUM SERUM-90,301,1 ,$100.00 ,$65.00 ,$20.28 ,$100.00 ,$65.00 ,$20.28 ,$28.00 ,$50.60 ,$20.28 ,$57.50 ,$20.28 ,$50.59 ,$20.28 ,$38.53 ,$82.00 ,$50.70 ,$20.28 ,$85.00 ,$90.00 ,$20.28 ,$75.00 ,$70.00 ,$74.00 ,$74.00 ,$50.70 ,$85.00 ,$20.28 ,$20.28 ,$70.10 ,$20.28 ,$41.60 , N/A ,$85.00 ,$43.60 ,$28.00 ,$90.00 ,$40.56 ,$20.28 ,$65.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101219,82507,HC CITRATE-90,301,1 ,$307.00 ,$199.55 ,$27.80 ,$307.00 ,$199.55 ,$27.80 ,$85.96 ,$155.34 ,$27.80 ,$176.53 ,$27.80 ,$155.31 ,$27.80 ,$52.82 ,$251.74 ,$69.50 ,$27.80 ,$260.95 ,$276.30 ,$27.80 ,$230.25 ,$214.90 ,$227.18 ,$227.18 ,$69.50 ,$260.95 ,$27.80 ,$27.80 ,$215.21 ,$27.80 ,$127.71 , N/A ,$260.95 ,$59.77 ,$85.96 ,$276.30 ,$55.60 ,$27.80 ,$199.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101220,82523,HC COLLAGEN CROSS LINKS ANY METHOD-90,301,1 ,$141.00 ,$91.65 ,$18.68 ,$141.00 ,$91.65 ,$18.68 ,$39.48 ,$71.35 ,$18.68 ,$81.08 ,$18.68 ,$71.33 ,$18.68 ,$35.49 ,$115.62 ,$46.70 ,$18.68 ,$119.85 ,$126.90 ,$18.68 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$46.70 ,$119.85 ,$18.68 ,$18.68 ,$98.84 ,$18.68 ,$58.66 , N/A ,$119.85 ,$40.16 ,$39.48 ,$126.90 ,$37.36 ,$18.68 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101221,82525,HC COPPER-90,301,1 ,$187.00 ,$121.55 ,$12.41 ,$187.00 ,$121.55 ,$12.41 ,$52.36 ,$94.62 ,$12.41 ,$107.53 ,$12.41 ,$94.60 ,$12.41 ,$23.58 ,$153.34 ,$31.03 ,$12.41 ,$158.95 ,$168.30 ,$12.41 ,$140.25 ,$130.90 ,$138.38 ,$138.38 ,$31.03 ,$158.95 ,$12.41 ,$12.41 ,$131.09 ,$12.41 ,$77.79 , N/A ,$158.95 ,$26.68 ,$52.36 ,$168.30 ,$24.82 ,$12.41 ,$121.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101222,82530,HC CORTISOL FREE-90,301,1 ,$229.00 ,$148.85 ,$16.71 ,$229.00 ,$148.85 ,$16.71 ,$64.12 ,$115.87 ,$16.71 ,$131.68 ,$16.71 ,$115.85 ,$16.71 ,$31.75 ,$187.78 ,$41.78 ,$16.71 ,$194.65 ,$206.10 ,$16.71 ,$171.75 ,$160.30 ,$169.46 ,$169.46 ,$41.78 ,$194.65 ,$16.71 ,$16.71 ,$160.53 ,$16.71 ,$95.26 , N/A ,$194.65 ,$35.93 ,$64.12 ,$206.10 ,$33.42 ,$16.71 ,$148.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101224,82542,HC CHROMO SPECTROMETRY -90,301,1 ,$191.00 ,$124.15 ,$24.09 ,$191.00 ,$124.15 ,$24.09 ,$53.48 ,$96.65 ,$24.09 ,$109.83 ,$24.09 ,$96.63 ,$24.09 ,$45.77 ,$156.62 ,$60.23 ,$24.09 ,$162.35 ,$171.90 ,$24.09 ,$143.25 ,$133.70 ,$141.34 ,$141.34 ,$60.23 ,$162.35 ,$24.09 ,$24.09 ,$133.89 ,$24.09 ,$79.46 , N/A ,$162.35 ,$51.79 ,$53.48 ,$171.90 ,$48.18 ,$24.09 ,$124.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101225,82550,HC CREATINE KINASE (CPK) TOTAL-90,301,1 ,$126.00 ,$81.90 ,$6.51 ,$126.00 ,$81.90 ,$6.51 ,$35.28 ,$63.76 ,$6.51 ,$72.45 ,$6.51 ,$63.74 ,$6.51 ,$12.37 ,$103.32 ,$16.28 ,$6.51 ,$107.10 ,$113.40 ,$6.51 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$16.28 ,$107.10 ,$6.51 ,$6.51 ,$88.33 ,$6.51 ,$52.42 , N/A ,$107.10 ,$14.00 ,$35.28 ,$113.40 ,$13.02 ,$6.51 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101226,82552,HC CREATINE KINASE (CPK) ISO-90,301,1 ,$44.00 ,$28.60 ,$12.32 ,$44.00 ,$28.60 ,$13.39 ,$12.32 ,$22.26 ,$13.39 ,$25.30 ,$13.39 ,$22.26 ,$13.39 ,$25.44 ,$36.08 ,$33.48 ,$13.39 ,$37.40 ,$39.60 ,$13.39 ,$33.00 ,$30.80 ,$32.56 ,$32.56 ,$33.48 ,$37.40 ,$13.39 ,$13.39 ,$30.84 ,$13.39 ,$18.30 , N/A ,$37.40 ,$28.79 ,$12.32 ,$39.60 ,$26.78 ,$13.39 ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101231,82570,HC CREATININE OTH SOURCE-90,301,1 ,$78.00 ,$50.70 ,$5.18 ,$78.00 ,$50.70 ,$5.18 ,$21.84 ,$39.47 ,$5.18 ,$44.85 ,$5.18 ,$39.46 ,$5.18 ,$9.84 ,$63.96 ,$12.95 ,$5.18 ,$66.30 ,$70.20 ,$5.18 ,$58.50 ,$54.60 ,$57.72 ,$57.72 ,$12.95 ,$66.30 ,$5.18 ,$5.18 ,$54.68 ,$5.18 ,$32.45 , N/A ,$66.30 ,$11.14 ,$21.84 ,$70.20 ,$10.36 ,$5.18 ,$50.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101233,82595,HC CRYOGLOBULIN QL OR SQN-90,301,1 ,$95.00 ,$61.75 ,$6.47 ,$95.00 ,$61.75 ,$6.47 ,$26.60 ,$48.07 ,$6.47 ,$54.63 ,$6.47 ,$48.06 ,$6.47 ,$12.29 ,$77.90 ,$16.18 ,$6.47 ,$80.75 ,$85.50 ,$6.47 ,$71.25 ,$66.50 ,$70.30 ,$70.30 ,$16.18 ,$80.75 ,$6.47 ,$6.47 ,$66.60 ,$6.47 ,$39.52 , N/A ,$80.75 ,$13.91 ,$26.60 ,$85.50 ,$12.94 ,$6.47 ,$61.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101234,82600,HC CYANIDE-90,301,1 ,$71.00 ,$46.15 ,$19.40 ,$71.00 ,$46.15 ,$19.40 ,$19.88 ,$35.93 ,$19.40 ,$40.83 ,$19.40 ,$35.92 ,$19.40 ,$36.86 ,$58.22 ,$48.50 ,$19.40 ,$60.35 ,$63.90 ,$19.40 ,$53.25 ,$49.70 ,$52.54 ,$52.54 ,$48.50 ,$60.35 ,$19.40 ,$19.40 ,$49.77 ,$19.40 ,$29.54 , N/A ,$60.35 ,$41.71 ,$19.88 ,$63.90 ,$38.80 ,$19.40 ,$46.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101236,82608,HC VITAMIN B-12 BINDING CAPACITY-90,301,1 ,$61.00 ,$39.65 ,$14.32 ,$61.00 ,$39.65 ,$14.32 ,$17.08 ,$30.87 ,$14.32 ,$35.08 ,$14.32 ,$30.86 ,$14.32 ,$27.21 ,$50.02 ,$35.80 ,$14.32 ,$51.85 ,$54.90 ,$14.32 ,$45.75 ,$42.70 ,$45.14 ,$45.14 ,$35.80 ,$51.85 ,$14.32 ,$14.32 ,$42.76 ,$14.32 ,$25.38 , N/A ,$51.85 ,$30.79 ,$17.08 ,$54.90 ,$28.64 ,$14.32 ,$39.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101237,82626,HC DHEA-90,301,1 ,$86.00 ,$55.90 ,$24.08 ,$86.00 ,$55.90 ,$25.27 ,$24.08 ,$43.52 ,$25.27 ,$49.45 ,$25.27 ,$43.51 ,$25.27 ,$48.01 ,$70.52 ,$63.18 ,$25.27 ,$73.10 ,$77.40 ,$25.27 ,$64.50 ,$60.20 ,$63.64 ,$63.64 ,$63.18 ,$73.10 ,$25.27 ,$25.27 ,$60.29 ,$25.27 ,$35.78 , N/A ,$73.10 ,$54.33 ,$24.08 ,$77.40 ,$50.54 ,$25.27 ,$55.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101238,82627,HC DHEA SULFATE-90,301,1 ,$150.00 ,$97.50 ,$22.23 ,$150.00 ,$97.50 ,$22.23 ,$42.00 ,$75.90 ,$22.23 ,$86.25 ,$22.23 ,$75.89 ,$22.23 ,$42.24 ,$123.00 ,$55.58 ,$22.23 ,$127.50 ,$135.00 ,$22.23 ,$112.50 ,$105.00 ,$111.00 ,$111.00 ,$55.58 ,$127.50 ,$22.23 ,$22.23 ,$105.15 ,$22.23 ,$62.40 , N/A ,$127.50 ,$47.79 ,$42.00 ,$135.00 ,$44.46 ,$22.23 ,$97.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101240,82652,HC VITAMIN D (1 25 DIHYDROXY)-90,301,1 ,$245.00 ,$159.25 ,$38.50 ,$245.00 ,$159.25 ,$38.50 ,$68.60 ,$123.97 ,$38.50 ,$140.88 ,$38.50 ,$123.95 ,$38.50 ,$73.15 ,$200.90 ,$96.25 ,$38.50 ,$208.25 ,$220.50 ,$38.50 ,$183.75 ,$171.50 ,$181.30 ,$181.30 ,$96.25 ,$208.25 ,$38.50 ,$38.50 ,$171.75 ,$38.50 ,$101.92 , N/A ,$208.25 ,$82.78 ,$68.60 ,$220.50 ,$77.00 ,$38.50 ,$159.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101241,82656,HC ELASTASE PANCREATIC EL1 FECAL QL OR SQN-90,301,1 ,$323.00 ,$209.95 ,$11.53 ,$323.00 ,$209.95 ,$11.53 ,$90.44 ,$163.44 ,$11.53 ,$185.73 ,$11.53 ,$163.41 ,$11.53 ,$21.91 ,$264.86 ,$28.83 ,$11.53 ,$274.55 ,$290.70 ,$11.53 ,$242.25 ,$226.10 ,$239.02 ,$239.02 ,$28.83 ,$274.55 ,$11.53 ,$11.53 ,$226.42 ,$11.53 ,$134.37 , N/A ,$274.55 ,$24.79 ,$90.44 ,$290.70 ,$23.06 ,$11.53 ,$209.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101245,82668,HC ERYTHROPOIETIN-90,301,1 ,$169.00 ,$109.85 ,$18.79 ,$169.00 ,$109.85 ,$18.79 ,$47.32 ,$85.51 ,$18.79 ,$97.18 ,$18.79 ,$85.50 ,$18.79 ,$35.70 ,$138.58 ,$46.98 ,$18.79 ,$143.65 ,$152.10 ,$18.79 ,$126.75 ,$118.30 ,$125.06 ,$125.06 ,$46.98 ,$143.65 ,$18.79 ,$18.79 ,$118.47 ,$18.79 ,$70.30 , N/A ,$143.65 ,$40.40 ,$47.32 ,$152.10 ,$37.58 ,$18.79 ,$109.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101246,82670,HC ESTRADIOL-90,301,1 ,$237.00 ,$154.05 ,$27.94 ,$237.00 ,$154.05 ,$27.94 ,$66.36 ,$119.92 ,$27.94 ,$136.28 ,$27.94 ,$119.90 ,$27.94 ,$53.09 ,$194.34 ,$69.85 ,$27.94 ,$201.45 ,$213.30 ,$27.94 ,$177.75 ,$165.90 ,$175.38 ,$175.38 ,$69.85 ,$201.45 ,$27.94 ,$27.94 ,$166.14 ,$27.94 ,$98.59 , N/A ,$201.45 ,$60.07 ,$66.36 ,$213.30 ,$55.88 ,$27.94 ,$154.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101248,82671,HC ESTROGEN FRACTIONATED-90,301,1 ,$184.00 ,$119.60 ,$32.30 ,$184.00 ,$119.60 ,$32.30 ,$51.52 ,$93.10 ,$32.30 ,$105.80 ,$32.30 ,$93.09 ,$32.30 ,$61.37 ,$150.88 ,$80.75 ,$32.30 ,$156.40 ,$165.60 ,$32.30 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$80.75 ,$156.40 ,$32.30 ,$32.30 ,$128.98 ,$32.30 ,$76.54 , N/A ,$156.40 ,$69.45 ,$51.52 ,$165.60 ,$64.60 ,$32.30 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101249,82672,HC ESTROGEN TOTAL-90,301,1 ,$183.00 ,$118.95 ,$21.70 ,$183.00 ,$118.95 ,$21.70 ,$51.24 ,$92.60 ,$21.70 ,$105.23 ,$21.70 ,$92.58 ,$21.70 ,$41.23 ,$150.06 ,$54.25 ,$21.70 ,$155.55 ,$164.70 ,$21.70 ,$137.25 ,$128.10 ,$135.42 ,$135.42 ,$54.25 ,$155.55 ,$21.70 ,$21.70 ,$128.28 ,$21.70 ,$76.13 , N/A ,$155.55 ,$46.66 ,$51.24 ,$164.70 ,$43.40 ,$21.70 ,$118.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101250,82677,HC ESTRIOL-90,301,1 ,$30.00 ,$19.50 ,$8.40 ,$60.45 ,$19.50 ,$24.18 ,$8.40 ,$15.18 ,$24.18 ,$17.25 ,$24.18 ,$15.18 ,$24.18 ,$30.00 ,$24.60 ,$60.45 ,$24.18 ,$25.50 ,$27.00 ,$24.18 ,$22.50 ,$21.00 ,$22.20 ,$22.20 ,$30.00 ,$25.50 ,$24.18 ,$24.18 ,$21.03 ,$24.18 ,$12.48 , N/A ,$25.50 ,$51.99 ,$8.40 ,$27.00 ,$30.00 ,$24.18 ,$19.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101251,82679,HC ESTRONE-90,301,1 ,$166.00 ,$107.90 ,$24.95 ,$166.00 ,$107.90 ,$24.95 ,$46.48 ,$84.00 ,$24.95 ,$95.45 ,$24.95 ,$83.98 ,$24.95 ,$47.41 ,$136.12 ,$62.38 ,$24.95 ,$141.10 ,$149.40 ,$24.95 ,$124.50 ,$116.20 ,$122.84 ,$122.84 ,$62.38 ,$141.10 ,$24.95 ,$24.95 ,$116.37 ,$24.95 ,$69.06 , N/A ,$141.10 ,$53.64 ,$46.48 ,$149.40 ,$49.90 ,$24.95 ,$107.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101253,82705,HC FECAL FAT QUALITATIVE-90,301,1 ,$93.00 ,$60.45 ,$5.10 ,$93.00 ,$60.45 ,$5.10 ,$26.04 ,$47.06 ,$5.10 ,$53.48 ,$5.10 ,$47.05 ,$5.10 ,$9.69 ,$76.26 ,$12.75 ,$5.10 ,$79.05 ,$83.70 ,$5.10 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$12.75 ,$79.05 ,$5.10 ,$5.10 ,$65.19 ,$5.10 ,$38.69 , N/A ,$79.05 ,$10.97 ,$26.04 ,$83.70 ,$10.20 ,$5.10 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101259,82747,HC FOLIC ACID RBC-90,301,1 ,$95.00 ,$61.75 ,$17.65 ,$95.00 ,$61.75 ,$17.65 ,$26.60 ,$48.07 ,$17.65 ,$54.63 ,$17.65 ,$48.06 ,$17.65 ,$33.54 ,$77.90 ,$44.13 ,$17.65 ,$80.75 ,$85.50 ,$17.65 ,$71.25 ,$66.50 ,$70.30 ,$70.30 ,$44.13 ,$80.75 ,$17.65 ,$17.65 ,$66.60 ,$17.65 ,$39.52 , N/A ,$80.75 ,$37.95 ,$26.60 ,$85.50 ,$35.30 ,$17.65 ,$61.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101262,82784,HC GAMMAGLOBULIN-90,301,1 ,$146.00 ,$94.90 ,$9.30 ,$146.00 ,$94.90 ,$9.30 ,$40.88 ,$73.88 ,$9.30 ,$83.95 ,$9.30 ,$73.86 ,$9.30 ,$17.67 ,$119.72 ,$23.25 ,$9.30 ,$124.10 ,$131.40 ,$9.30 ,$109.50 ,$102.20 ,$108.04 ,$108.04 ,$23.25 ,$124.10 ,$9.30 ,$9.30 ,$102.35 ,$9.30 ,$60.74 , N/A ,$124.10 ,$20.00 ,$40.88 ,$131.40 ,$18.60 ,$9.30 ,$94.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101263,82785,HC GAMMAGLOBULIN IGE-90,301,1 ,$187.00 ,$121.55 ,$16.46 ,$187.00 ,$121.55 ,$16.46 ,$52.36 ,$94.62 ,$16.46 ,$107.53 ,$16.46 ,$94.60 ,$16.46 ,$31.27 ,$153.34 ,$41.15 ,$16.46 ,$158.95 ,$168.30 ,$16.46 ,$140.25 ,$130.90 ,$138.38 ,$138.38 ,$41.15 ,$158.95 ,$16.46 ,$16.46 ,$131.09 ,$16.46 ,$77.79 , N/A ,$158.95 ,$35.39 ,$52.36 ,$168.30 ,$32.92 ,$16.46 ,$121.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101265,82787,HC IMMUNOGLOBULIN SUBCLASSES-90,301,1 ,$67.00 ,$43.55 ,$8.02 ,$67.00 ,$43.55 ,$8.02 ,$18.76 ,$33.90 ,$8.02 ,$38.53 ,$8.02 ,$33.90 ,$8.02 ,$15.24 ,$54.94 ,$20.05 ,$8.02 ,$56.95 ,$60.30 ,$8.02 ,$50.25 ,$46.90 ,$49.58 ,$49.58 ,$20.05 ,$56.95 ,$8.02 ,$8.02 ,$46.97 ,$8.02 ,$27.87 , N/A ,$56.95 ,$17.24 ,$18.76 ,$60.30 ,$16.04 ,$8.02 ,$43.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101268,82941,HC GASTRIN-90,301,1 ,$113.00 ,$73.45 ,$17.63 ,$113.00 ,$73.45 ,$17.63 ,$31.64 ,$57.18 ,$17.63 ,$64.98 ,$17.63 ,$57.17 ,$17.63 ,$33.50 ,$92.66 ,$44.08 ,$17.63 ,$96.05 ,$101.70 ,$17.63 ,$84.75 ,$79.10 ,$83.62 ,$83.62 ,$44.08 ,$96.05 ,$17.63 ,$17.63 ,$79.21 ,$17.63 ,$47.01 , N/A ,$96.05 ,$37.90 ,$31.64 ,$101.70 ,$35.26 ,$17.63 ,$73.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101274,82955,HC G6PD ENZYME QN-90,301,1 ,$18.00 ,$11.70 ,$5.04 ,$24.25 ,$11.70 ,$9.70 ,$5.04 ,$9.11 ,$9.70 ,$10.35 ,$9.70 ,$9.11 ,$9.70 ,$18.00 ,$14.76 ,$24.25 ,$9.70 ,$15.30 ,$16.20 ,$9.70 ,$13.50 ,$12.60 ,$13.32 ,$13.32 ,$18.00 ,$15.30 ,$9.70 ,$9.70 ,$12.62 ,$9.70 ,$7.49 , N/A ,$15.30 ,$20.86 ,$5.04 ,$16.20 ,$18.00 ,$9.70 ,$11.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101276,82985,HC FRUCTOSAMINE-90,301,1 ,$78.00 ,$50.70 ,$16.76 ,$78.00 ,$50.70 ,$16.76 ,$21.84 ,$39.47 ,$16.76 ,$44.85 ,$16.76 ,$39.46 ,$16.76 ,$31.84 ,$63.96 ,$41.90 ,$16.76 ,$66.30 ,$70.20 ,$16.76 ,$58.50 ,$54.60 ,$57.72 ,$57.72 ,$41.90 ,$66.30 ,$16.76 ,$16.76 ,$54.68 ,$16.76 ,$32.45 , N/A ,$66.30 ,$36.03 ,$21.84 ,$70.20 ,$33.52 ,$16.76 ,$50.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101279,83003,HC GROWTH HORMONE (HGH)-90,301,1 ,$171.00 ,$111.15 ,$16.67 ,$171.00 ,$111.15 ,$16.67 ,$47.88 ,$86.53 ,$16.67 ,$98.33 ,$16.67 ,$86.51 ,$16.67 ,$31.67 ,$140.22 ,$41.68 ,$16.67 ,$145.35 ,$153.90 ,$16.67 ,$128.25 ,$119.70 ,$126.54 ,$126.54 ,$41.68 ,$145.35 ,$16.67 ,$16.67 ,$119.87 ,$16.67 ,$71.14 , N/A ,$145.35 ,$35.84 ,$47.88 ,$153.90 ,$33.34 ,$16.67 ,$111.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101282,83013,HC H PYLORI BREATH TEST-90,301,1 ,$284.00 ,$184.60 ,$67.36 ,$284.00 ,$184.60 ,$67.36 ,$79.52 ,$143.70 ,$67.36 ,$163.30 ,$67.36 ,$143.68 ,$67.36 ,$127.98 ,$232.88 ,$168.40 ,$67.36 ,$241.40 ,$255.60 ,$67.36 ,$213.00 ,$198.80 ,$210.16 ,$210.16 ,$168.40 ,$241.40 ,$67.36 ,$67.36 ,$199.08 ,$67.36 ,$118.14 , N/A ,$241.40 ,$144.82 ,$79.52 ,$255.60 ,$134.72 ,$67.36 ,$184.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101283,83018,HC HEAVY METAL QN EACH-90,301,1 ,$134.00 ,$87.10 ,$21.96 ,$134.00 ,$87.10 ,$21.96 ,$37.52 ,$67.80 ,$21.96 ,$77.05 ,$21.96 ,$67.79 ,$21.96 ,$41.72 ,$109.88 ,$54.90 ,$21.96 ,$113.90 ,$120.60 ,$21.96 ,$100.50 ,$93.80 ,$99.16 ,$99.16 ,$54.90 ,$113.90 ,$21.96 ,$21.96 ,$93.93 ,$21.96 ,$55.74 , N/A ,$113.90 ,$47.21 ,$37.52 ,$120.60 ,$43.92 ,$21.96 ,$87.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101284,83020,HC HGB ELECTROPHORESIS-90,301,1 ,$63.00 ,$40.95 ,$12.87 ,$63.00 ,$40.95 ,$12.87 ,$17.64 ,$31.88 ,$12.87 ,$36.23 ,$12.87 ,$31.87 ,$12.87 ,$24.45 ,$51.66 ,$32.18 ,$12.87 ,$53.55 ,$56.70 ,$12.87 ,$47.25 ,$44.10 ,$46.62 ,$46.62 ,$32.18 ,$53.55 ,$12.87 ,$12.87 ,$44.16 ,$12.87 ,$26.21 , N/A ,$53.55 ,$27.67 ,$17.64 ,$56.70 ,$25.74 ,$12.87 ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101289,83051,HC HEMOGLOBIN PLASMA-90,301,1 ,$52.00 ,$33.80 ,$7.31 ,$52.00 ,$33.80 ,$7.31 ,$14.56 ,$26.31 ,$7.31 ,$29.90 ,$7.31 ,$26.31 ,$7.31 ,$13.89 ,$42.64 ,$18.28 ,$7.31 ,$44.20 ,$46.80 ,$7.31 ,$39.00 ,$36.40 ,$38.48 ,$38.48 ,$18.28 ,$44.20 ,$7.31 ,$7.31 ,$36.45 ,$7.31 ,$21.63 , N/A ,$44.20 ,$15.72 ,$14.56 ,$46.80 ,$14.62 ,$7.31 ,$33.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101292,83090,HC HOMOCYSTEINE-90,301,1 ,$216.00 ,$140.40 ,$17.92 ,$216.00 ,$140.40 ,$17.92 ,$60.48 ,$109.30 ,$17.92 ,$124.20 ,$17.92 ,$109.27 ,$17.92 ,$34.05 ,$177.12 ,$44.80 ,$17.92 ,$183.60 ,$194.40 ,$17.92 ,$162.00 ,$151.20 ,$159.84 ,$159.84 ,$44.80 ,$183.60 ,$17.92 ,$17.92 ,$151.42 ,$17.92 ,$89.86 , N/A ,$183.60 ,$38.53 ,$60.48 ,$194.40 ,$35.84 ,$17.92 ,$140.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101294,83497,HC HYDROXYINDOLACET 5 (HIAA)-90,301,1 ,$65.00 ,$42.25 ,$12.90 ,$65.00 ,$42.25 ,$12.90 ,$18.20 ,$32.89 ,$12.90 ,$37.38 ,$12.90 ,$32.88 ,$12.90 ,$24.51 ,$53.30 ,$32.25 ,$12.90 ,$55.25 ,$58.50 ,$12.90 ,$48.75 ,$45.50 ,$48.10 ,$48.10 ,$32.25 ,$55.25 ,$12.90 ,$12.90 ,$45.57 ,$12.90 ,$27.04 , N/A ,$55.25 ,$27.74 ,$18.20 ,$58.50 ,$25.80 ,$12.90 ,$42.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101295,83498,HC HYDROXYPROGESTERONE 17D-90,301,1 ,$275.00 ,$178.75 ,$27.17 ,$275.00 ,$178.75 ,$27.17 ,$77.00 ,$139.15 ,$27.17 ,$158.13 ,$27.17 ,$139.12 ,$27.17 ,$51.62 ,$225.50 ,$67.93 ,$27.17 ,$233.75 ,$247.50 ,$27.17 ,$206.25 ,$192.50 ,$203.50 ,$203.50 ,$67.93 ,$233.75 ,$27.17 ,$27.17 ,$192.78 ,$27.17 ,$114.40 , N/A ,$233.75 ,$58.42 ,$77.00 ,$247.50 ,$54.34 ,$27.17 ,$178.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101297,83516,HC MLT NON INFECT QL/SQ-90,301,1 ,$121.00 ,$78.65 ,$11.53 ,$121.00 ,$78.65 ,$11.53 ,$33.88 ,$61.23 ,$11.53 ,$69.58 ,$11.53 ,$61.21 ,$11.53 ,$21.91 ,$99.22 ,$28.83 ,$11.53 ,$102.85 ,$108.90 ,$11.53 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$28.83 ,$102.85 ,$11.53 ,$11.53 ,$84.82 ,$11.53 ,$50.34 , N/A ,$102.85 ,$24.79 ,$33.88 ,$108.90 ,$23.06 ,$11.53 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101302,83519,HC QN RIA-90,301,1 ,$220.00 ,$143.00 ,$18.40 ,$220.00 ,$143.00 ,$18.40 ,$61.60 ,$111.32 ,$18.40 ,$126.50 ,$18.40 ,$111.30 ,$18.40 ,$34.96 ,$180.40 ,$46.00 ,$18.40 ,$187.00 ,$198.00 ,$18.40 ,$165.00 ,$154.00 ,$162.80 ,$162.80 ,$46.00 ,$187.00 ,$18.40 ,$18.40 ,$154.22 ,$18.40 ,$91.52 , N/A ,$187.00 ,$39.56 ,$61.60 ,$198.00 ,$36.80 ,$18.40 ,$143.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101303,83520,HC IMMUNOASSAY QN OTHER-90,301,1 ,$169.00 ,$109.85 ,$17.27 ,$169.00 ,$109.85 ,$17.27 ,$47.32 ,$85.51 ,$17.27 ,$97.18 ,$17.27 ,$85.50 ,$17.27 ,$32.81 ,$138.58 ,$43.18 ,$17.27 ,$143.65 ,$152.10 ,$17.27 ,$126.75 ,$118.30 ,$125.06 ,$125.06 ,$43.18 ,$143.65 ,$17.27 ,$17.27 ,$118.47 ,$17.27 ,$70.30 , N/A ,$143.65 ,$37.13 ,$47.32 ,$152.10 ,$34.54 ,$17.27 ,$109.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101307,83525,HC INSULIN TOTAL-90,301,1 ,$140.00 ,$91.00 ,$11.43 ,$140.00 ,$91.00 ,$11.43 ,$39.20 ,$70.84 ,$11.43 ,$80.50 ,$11.43 ,$70.83 ,$11.43 ,$21.72 ,$114.80 ,$28.58 ,$11.43 ,$119.00 ,$126.00 ,$11.43 ,$105.00 ,$98.00 ,$103.60 ,$103.60 ,$28.58 ,$119.00 ,$11.43 ,$11.43 ,$98.14 ,$11.43 ,$58.24 , N/A ,$119.00 ,$24.57 ,$39.20 ,$126.00 ,$22.86 ,$11.43 ,$91.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101311,83605,HC LACTATE/LACTIC ACID-90,301,1 ,$23.64 ,$15.37 ,$6.62 ,$28.93 ,$15.37 ,$11.57 ,$6.62 ,$11.96 ,$11.57 ,$13.59 ,$11.57 ,$11.96 ,$11.57 ,$21.98 ,$19.38 ,$28.93 ,$11.57 ,$20.09 ,$21.28 ,$11.57 ,$17.73 ,$16.55 ,$17.49 ,$17.49 ,$23.64 ,$20.09 ,$11.57 ,$11.57 ,$16.57 ,$11.57 ,$9.83 , N/A ,$20.09 ,$24.88 ,$6.62 ,$21.28 ,$23.14 ,$11.57 ,$15.37 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101312,83615,HC LACTATE DEHYDRO (LDH)-90,301,1 ,$102.00 ,$66.30 ,$6.04 ,$102.00 ,$66.30 ,$6.04 ,$28.56 ,$51.61 ,$6.04 ,$58.65 ,$6.04 ,$51.60 ,$6.04 ,$11.48 ,$83.64 ,$15.10 ,$6.04 ,$86.70 ,$91.80 ,$6.04 ,$76.50 ,$71.40 ,$75.48 ,$75.48 ,$15.10 ,$86.70 ,$6.04 ,$6.04 ,$71.50 ,$6.04 ,$42.43 , N/A ,$86.70 ,$12.99 ,$28.56 ,$91.80 ,$12.08 ,$6.04 ,$66.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101316,83655,HC LEAD-90,301,1 ,$117.00 ,$76.05 ,$12.11 ,$117.00 ,$76.05 ,$12.11 ,$32.76 ,$59.20 ,$12.11 ,$67.28 ,$12.11 ,$59.19 ,$12.11 ,$23.01 ,$95.94 ,$30.28 ,$12.11 ,$99.45 ,$105.30 ,$12.11 ,$87.75 ,$81.90 ,$86.58 ,$86.58 ,$30.28 ,$99.45 ,$12.11 ,$12.11 ,$82.02 ,$12.11 ,$48.67 , N/A ,$99.45 ,$26.04 ,$32.76 ,$105.30 ,$24.22 ,$12.11 ,$76.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101319,83695,HC LIPOPROTEIN-90,301,1 ,$159.00 ,$103.35 ,$14.32 ,$159.00 ,$103.35 ,$14.32 ,$44.52 ,$80.45 ,$14.32 ,$91.43 ,$14.32 ,$80.44 ,$14.32 ,$27.21 ,$130.38 ,$35.80 ,$14.32 ,$135.15 ,$143.10 ,$14.32 ,$119.25 ,$111.30 ,$117.66 ,$117.66 ,$35.80 ,$135.15 ,$14.32 ,$14.32 ,$111.46 ,$14.32 ,$66.14 , N/A ,$135.15 ,$30.79 ,$44.52 ,$143.10 ,$28.64 ,$14.32 ,$103.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101326,83735,HC MAGNESIUM-90,301,1 ,$80.00 ,$52.00 ,$6.70 ,$80.00 ,$52.00 ,$6.70 ,$22.40 ,$40.48 ,$6.70 ,$46.00 ,$6.70 ,$40.47 ,$6.70 ,$12.73 ,$65.60 ,$16.75 ,$6.70 ,$68.00 ,$72.00 ,$6.70 ,$60.00 ,$56.00 ,$59.20 ,$59.20 ,$16.75 ,$68.00 ,$6.70 ,$6.70 ,$56.08 ,$6.70 ,$33.28 , N/A ,$68.00 ,$14.41 ,$22.40 ,$72.00 ,$13.40 ,$6.70 ,$52.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101327,83785,HC MANGANESE-90,301,1 ,$164.00 ,$106.60 ,$26.65 ,$164.00 ,$106.60 ,$26.65 ,$45.92 ,$82.98 ,$26.65 ,$94.30 ,$26.65 ,$82.97 ,$26.65 ,$50.64 ,$134.48 ,$66.63 ,$26.65 ,$139.40 ,$147.60 ,$26.65 ,$123.00 ,$114.80 ,$121.36 ,$121.36 ,$66.63 ,$139.40 ,$26.65 ,$26.65 ,$114.96 ,$26.65 ,$68.22 , N/A ,$139.40 ,$57.30 ,$45.92 ,$147.60 ,$53.30 ,$26.65 ,$106.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101328,83789,HC MASS SPEC QN EACH-90,301,1 ,$215.00 ,$139.75 ,$24.11 ,$215.00 ,$139.75 ,$24.11 ,$60.20 ,$108.79 ,$24.11 ,$123.63 ,$24.11 ,$108.77 ,$24.11 ,$45.81 ,$176.30 ,$60.28 ,$24.11 ,$182.75 ,$193.50 ,$24.11 ,$161.25 ,$150.50 ,$159.10 ,$159.10 ,$60.28 ,$182.75 ,$24.11 ,$24.11 ,$150.72 ,$24.11 ,$89.44 , N/A ,$182.75 ,$51.84 ,$60.20 ,$193.50 ,$48.22 ,$24.11 ,$139.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101329,83825,HC MERCURY-90,301,1 ,$82.00 ,$53.30 ,$16.26 ,$82.00 ,$53.30 ,$16.26 ,$22.96 ,$41.49 ,$16.26 ,$47.15 ,$16.26 ,$41.48 ,$16.26 ,$30.89 ,$67.24 ,$40.65 ,$16.26 ,$69.70 ,$73.80 ,$16.26 ,$61.50 ,$57.40 ,$60.68 ,$60.68 ,$40.65 ,$69.70 ,$16.26 ,$16.26 ,$57.48 ,$16.26 ,$34.11 , N/A ,$69.70 ,$34.96 ,$22.96 ,$73.80 ,$32.52 ,$16.26 ,$53.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101330,83835,HC METANEPHRINES-90,301,1 ,$111.00 ,$72.15 ,$16.94 ,$111.00 ,$72.15 ,$16.94 ,$31.08 ,$56.17 ,$16.94 ,$63.83 ,$16.94 ,$56.15 ,$16.94 ,$32.19 ,$91.02 ,$42.35 ,$16.94 ,$94.35 ,$99.90 ,$16.94 ,$83.25 ,$77.70 ,$82.14 ,$82.14 ,$42.35 ,$94.35 ,$16.94 ,$16.94 ,$77.81 ,$16.94 ,$46.18 , N/A ,$94.35 ,$36.42 ,$31.08 ,$99.90 ,$33.88 ,$16.94 ,$72.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101333,83873,HC MYELIN BASIC PROTEIN (CSF)-90,301,1 ,$66.00 ,$42.90 ,$17.20 ,$66.00 ,$42.90 ,$17.20 ,$18.48 ,$33.40 ,$17.20 ,$37.95 ,$17.20 ,$33.39 ,$17.20 ,$32.68 ,$54.12 ,$43.00 ,$17.20 ,$56.10 ,$59.40 ,$17.20 ,$49.50 ,$46.20 ,$48.84 ,$48.84 ,$43.00 ,$56.10 ,$17.20 ,$17.20 ,$46.27 ,$17.20 ,$27.46 , N/A ,$56.10 ,$36.98 ,$18.48 ,$59.40 ,$34.40 ,$17.20 ,$42.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101334,83874,HC MYOGLOBIN-90,301,1 ,$114.00 ,$74.10 ,$12.92 ,$114.00 ,$74.10 ,$12.92 ,$31.92 ,$57.68 ,$12.92 ,$65.55 ,$12.92 ,$57.67 ,$12.92 ,$24.55 ,$93.48 ,$32.30 ,$12.92 ,$96.90 ,$102.60 ,$12.92 ,$85.50 ,$79.80 ,$84.36 ,$84.36 ,$32.30 ,$96.90 ,$12.92 ,$12.92 ,$79.91 ,$12.92 ,$47.42 , N/A ,$96.90 ,$27.78 ,$31.92 ,$102.60 ,$25.84 ,$12.92 ,$74.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101337,83883,HC NEPHELOMETRY EA ANALYTE-90,301,1 ,$137.00 ,$89.05 ,$13.60 ,$137.00 ,$89.05 ,$13.60 ,$38.36 ,$69.32 ,$13.60 ,$78.78 ,$13.60 ,$69.31 ,$13.60 ,$25.84 ,$112.34 ,$34.00 ,$13.60 ,$116.45 ,$123.30 ,$13.60 ,$102.75 ,$95.90 ,$101.38 ,$101.38 ,$34.00 ,$116.45 ,$13.60 ,$13.60 ,$96.04 ,$13.60 ,$56.99 , N/A ,$116.45 ,$29.24 ,$38.36 ,$123.30 ,$27.20 ,$13.60 ,$89.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101339,83915,HC NUCLEOTIDASE 5 -90,301,1 ,$117.00 ,$76.05 ,$11.15 ,$117.00 ,$76.05 ,$11.15 ,$32.76 ,$59.20 ,$11.15 ,$67.28 ,$11.15 ,$59.19 ,$11.15 ,$21.19 ,$95.94 ,$27.88 ,$11.15 ,$99.45 ,$105.30 ,$11.15 ,$87.75 ,$81.90 ,$86.58 ,$86.58 ,$27.88 ,$99.45 ,$11.15 ,$11.15 ,$82.02 ,$11.15 ,$48.67 , N/A ,$99.45 ,$23.97 ,$32.76 ,$105.30 ,$22.30 ,$11.15 ,$76.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101340,83916,HC OLIGOCLONAL BANDS-90,301,1 ,$100.00 ,$65.00 ,$27.39 ,$100.00 ,$65.00 ,$27.39 ,$28.00 ,$50.60 ,$27.39 ,$57.50 ,$27.39 ,$50.59 ,$27.39 ,$52.04 ,$82.00 ,$68.48 ,$27.39 ,$85.00 ,$90.00 ,$27.39 ,$75.00 ,$70.00 ,$74.00 ,$74.00 ,$68.48 ,$85.00 ,$27.39 ,$27.39 ,$70.10 ,$27.39 ,$41.60 , N/A ,$85.00 ,$58.89 ,$28.00 ,$90.00 ,$54.78 ,$27.39 ,$65.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101344,83937,HC OSTEOCALCIN-90,301,1 ,$91.00 ,$59.15 ,$25.48 ,$91.00 ,$59.15 ,$29.85 ,$25.48 ,$46.05 ,$29.85 ,$52.33 ,$29.85 ,$46.04 ,$29.85 ,$56.72 ,$74.62 ,$74.63 ,$29.85 ,$77.35 ,$81.90 ,$29.85 ,$68.25 ,$63.70 ,$67.34 ,$67.34 ,$74.63 ,$77.35 ,$29.85 ,$29.85 ,$63.79 ,$29.85 ,$37.86 , N/A ,$77.35 ,$64.18 ,$25.48 ,$81.90 ,$59.70 ,$29.85 ,$59.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101345,83945,HC OXALATE-90,301,1 ,$150.00 ,$97.50 ,$14.45 ,$150.00 ,$97.50 ,$14.45 ,$42.00 ,$75.90 ,$14.45 ,$86.25 ,$14.45 ,$75.89 ,$14.45 ,$27.46 ,$123.00 ,$36.13 ,$14.45 ,$127.50 ,$135.00 ,$14.45 ,$112.50 ,$105.00 ,$111.00 ,$111.00 ,$36.13 ,$127.50 ,$14.45 ,$14.45 ,$105.15 ,$14.45 ,$62.40 , N/A ,$127.50 ,$31.07 ,$42.00 ,$135.00 ,$28.90 ,$14.45 ,$97.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101351,83993,HC CALPROTECTIN STOOL-90,301,1 ,$284.00 ,$184.60 ,$19.63 ,$284.00 ,$184.60 ,$19.63 ,$79.52 ,$143.70 ,$19.63 ,$163.30 ,$19.63 ,$143.68 ,$19.63 ,$37.30 ,$232.88 ,$49.08 ,$19.63 ,$241.40 ,$255.60 ,$19.63 ,$213.00 ,$198.80 ,$210.16 ,$210.16 ,$49.08 ,$241.40 ,$19.63 ,$19.63 ,$199.08 ,$19.63 ,$118.14 , N/A ,$241.40 ,$42.20 ,$79.52 ,$255.60 ,$39.26 ,$19.63 ,$184.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101353,84066,HC PHOSPHATASE ACID PROSTATIC-90,301,1 ,$58.00 ,$37.70 ,$9.66 ,$58.00 ,$37.70 ,$9.66 ,$16.24 ,$29.35 ,$9.66 ,$33.35 ,$9.66 ,$29.34 ,$9.66 ,$18.35 ,$47.56 ,$24.15 ,$9.66 ,$49.30 ,$52.20 ,$9.66 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$24.15 ,$49.30 ,$9.66 ,$9.66 ,$40.66 ,$9.66 ,$24.13 , N/A ,$49.30 ,$20.77 ,$16.24 ,$52.20 ,$19.32 ,$9.66 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101354,84075,HC ALKALINE PHOSPHATASE-90,301,1 ,$232.00 ,$150.80 ,$5.18 ,$232.00 ,$150.80 ,$5.18 ,$64.96 ,$117.39 ,$5.18 ,$133.40 ,$5.18 ,$117.37 ,$5.18 ,$9.84 ,$190.24 ,$12.95 ,$5.18 ,$197.20 ,$208.80 ,$5.18 ,$174.00 ,$162.40 ,$171.68 ,$171.68 ,$12.95 ,$197.20 ,$5.18 ,$5.18 ,$162.63 ,$5.18 ,$96.51 , N/A ,$197.20 ,$11.14 ,$64.96 ,$208.80 ,$10.36 ,$5.18 ,$150.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101356,84080,HC ALK PHOS ISOENZ-90,301,1 ,$74.00 ,$48.10 ,$14.78 ,$74.00 ,$48.10 ,$14.78 ,$20.72 ,$37.44 ,$14.78 ,$42.55 ,$14.78 ,$37.44 ,$14.78 ,$28.08 ,$60.68 ,$36.95 ,$14.78 ,$62.90 ,$66.60 ,$14.78 ,$55.50 ,$51.80 ,$54.76 ,$54.76 ,$36.95 ,$62.90 ,$14.78 ,$14.78 ,$51.87 ,$14.78 ,$30.78 , N/A ,$62.90 ,$31.78 ,$20.72 ,$66.60 ,$29.56 ,$14.78 ,$48.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101361,84120,HC PORPHYRINS QN FRACT-90,301,1 ,$72.00 ,$46.80 ,$14.71 ,$72.00 ,$46.80 ,$14.71 ,$20.16 ,$36.43 ,$14.71 ,$41.40 ,$14.71 ,$36.42 ,$14.71 ,$27.95 ,$59.04 ,$36.78 ,$14.71 ,$61.20 ,$64.80 ,$14.71 ,$54.00 ,$50.40 ,$53.28 ,$53.28 ,$36.78 ,$61.20 ,$14.71 ,$14.71 ,$50.47 ,$14.71 ,$29.95 , N/A ,$61.20 ,$31.63 ,$20.16 ,$64.80 ,$29.42 ,$14.71 ,$46.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101364,84133,HC POTASSIUM URINE-90,301,1 ,$93.00 ,$60.45 ,$4.73 ,$93.00 ,$60.45 ,$4.73 ,$26.04 ,$47.06 ,$4.73 ,$53.48 ,$4.73 ,$47.05 ,$4.73 ,$8.99 ,$76.26 ,$11.83 ,$4.73 ,$79.05 ,$83.70 ,$4.73 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$11.83 ,$79.05 ,$4.73 ,$4.73 ,$65.19 ,$4.73 ,$38.69 , N/A ,$79.05 ,$10.17 ,$26.04 ,$83.70 ,$9.46 ,$4.73 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101365,84134,HC PREALBUMIN-90,301,1 ,$142.00 ,$92.30 ,$14.59 ,$142.00 ,$92.30 ,$14.59 ,$39.76 ,$71.85 ,$14.59 ,$81.65 ,$14.59 ,$71.84 ,$14.59 ,$27.72 ,$116.44 ,$36.48 ,$14.59 ,$120.70 ,$127.80 ,$14.59 ,$106.50 ,$99.40 ,$105.08 ,$105.08 ,$36.48 ,$120.70 ,$14.59 ,$14.59 ,$99.54 ,$14.59 ,$59.07 , N/A ,$120.70 ,$31.37 ,$39.76 ,$127.80 ,$29.18 ,$14.59 ,$92.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101366,84140,HC PREGNENOLONE-90,301,1 ,$274.00 ,$178.10 ,$20.67 ,$274.00 ,$178.10 ,$20.67 ,$76.72 ,$138.64 ,$20.67 ,$157.55 ,$20.67 ,$138.62 ,$20.67 ,$39.27 ,$224.68 ,$51.68 ,$20.67 ,$232.90 ,$246.60 ,$20.67 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$51.68 ,$232.90 ,$20.67 ,$20.67 ,$192.07 ,$20.67 ,$113.98 , N/A ,$232.90 ,$44.44 ,$76.72 ,$246.60 ,$41.34 ,$20.67 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101368,84144,HC PROGESTERONE-90,301,1 ,$184.00 ,$119.60 ,$20.86 ,$184.00 ,$119.60 ,$20.86 ,$51.52 ,$93.10 ,$20.86 ,$105.80 ,$20.86 ,$93.09 ,$20.86 ,$39.63 ,$150.88 ,$52.15 ,$20.86 ,$156.40 ,$165.60 ,$20.86 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$52.15 ,$156.40 ,$20.86 ,$20.86 ,$128.98 ,$20.86 ,$76.54 , N/A ,$156.40 ,$44.85 ,$51.52 ,$165.60 ,$41.72 ,$20.86 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101372,84155,HC PROTEIN TOTAL-90,301,1 ,$58.00 ,$37.70 ,$3.67 ,$58.00 ,$37.70 ,$3.67 ,$16.24 ,$29.35 ,$3.67 ,$33.35 ,$3.67 ,$29.34 ,$3.67 ,$6.97 ,$47.56 ,$9.18 ,$3.67 ,$49.30 ,$52.20 ,$3.67 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$9.18 ,$49.30 ,$3.67 ,$3.67 ,$40.66 ,$3.67 ,$24.13 , N/A ,$49.30 ,$7.89 ,$16.24 ,$52.20 ,$7.34 ,$3.67 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101373,84156,HC PROTEIN TOTAL URINE-90,301,1 ,$102.00 ,$66.30 ,$3.67 ,$102.00 ,$66.30 ,$3.67 ,$28.56 ,$51.61 ,$3.67 ,$58.65 ,$3.67 ,$51.60 ,$3.67 ,$6.97 ,$83.64 ,$9.18 ,$3.67 ,$86.70 ,$91.80 ,$3.67 ,$76.50 ,$71.40 ,$75.48 ,$75.48 ,$9.18 ,$86.70 ,$3.67 ,$3.67 ,$71.50 ,$3.67 ,$42.43 , N/A ,$86.70 ,$7.89 ,$28.56 ,$91.80 ,$7.34 ,$3.67 ,$66.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101374,84157,HC PROTEIN TOTAL OTH SRC-90,301,1 ,$29.56 ,$19.21 ,$4.00 ,$29.56 ,$19.21 ,$4.00 ,$8.28 ,$14.96 ,$4.00 ,$17.00 ,$4.00 ,$14.95 ,$4.00 ,$7.60 ,$24.24 ,$10.00 ,$4.00 ,$25.13 ,$26.60 ,$4.00 ,$22.17 ,$20.69 ,$21.87 ,$21.87 ,$10.00 ,$25.13 ,$4.00 ,$4.00 ,$20.72 ,$4.00 ,$12.30 , N/A ,$25.13 ,$8.60 ,$8.28 ,$26.60 ,$8.00 ,$4.00 ,$19.21 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101375,84165,HC PROTEIN ELECTROPHORESIS-90,301,1 ,$180.00 ,$117.00 ,$10.74 ,$180.00 ,$117.00 ,$10.74 ,$50.40 ,$91.08 ,$10.74 ,$103.50 ,$10.74 ,$91.06 ,$10.74 ,$20.41 ,$147.60 ,$26.85 ,$10.74 ,$153.00 ,$162.00 ,$10.74 ,$135.00 ,$126.00 ,$133.20 ,$133.20 ,$26.85 ,$153.00 ,$10.74 ,$10.74 ,$126.18 ,$10.74 ,$74.88 , N/A ,$153.00 ,$23.09 ,$50.40 ,$162.00 ,$21.48 ,$10.74 ,$117.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101377,84166,HC PROTEIN EP OTH FLUID-90,301,1 ,$180.00 ,$117.00 ,$17.83 ,$180.00 ,$117.00 ,$17.83 ,$50.40 ,$91.08 ,$17.83 ,$103.50 ,$17.83 ,$91.06 ,$17.83 ,$33.88 ,$147.60 ,$44.58 ,$17.83 ,$153.00 ,$162.00 ,$17.83 ,$135.00 ,$126.00 ,$133.20 ,$133.20 ,$44.58 ,$153.00 ,$17.83 ,$17.83 ,$126.18 ,$17.83 ,$74.88 , N/A ,$153.00 ,$38.33 ,$50.40 ,$162.00 ,$35.66 ,$17.83 ,$117.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101379,84181,HC PROTEIN WESTERN BLOT-90,301,1 ,"$1,384.00 ",$899.60 ,$17.03 ,"$1,384.00 ",$899.60 ,$17.03 ,$387.52 ,$700.30 ,$17.03 ,$795.80 ,$17.03 ,$700.17 ,$17.03 ,$32.36 ,"$1,134.88 ",$42.58 ,$17.03 ,"$1,176.40 ","$1,245.60 ",$17.03 ,"$1,038.00 ",$968.80 ,"$1,024.16 ","$1,024.16 ",$42.58 ,"$1,176.40 ",$17.03 ,$17.03 ,$970.18 ,$17.03 ,$575.74 , N/A ,"$1,176.40 ",$36.61 ,$387.52 ,"$1,245.60 ",$34.06 ,$17.03 ,$899.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101380,84182,HC PROTEIN WEST BLOT BAND ID-90,301,1 ,$106.00 ,$68.90 ,$29.21 ,$106.00 ,$68.90 ,$29.21 ,$29.68 ,$53.64 ,$29.21 ,$60.95 ,$29.21 ,$53.63 ,$29.21 ,$55.50 ,$86.92 ,$73.03 ,$29.21 ,$90.10 ,$95.40 ,$29.21 ,$79.50 ,$74.20 ,$78.44 ,$78.44 ,$73.03 ,$90.10 ,$29.21 ,$29.21 ,$74.31 ,$29.21 ,$44.10 , N/A ,$90.10 ,$62.80 ,$29.68 ,$95.40 ,$58.42 ,$29.21 ,$68.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101381,84202,HC PROTOPORPHYRIN-90,301,1 ,$69.00 ,$44.85 ,$14.35 ,$69.00 ,$44.85 ,$14.35 ,$19.32 ,$34.91 ,$14.35 ,$39.68 ,$14.35 ,$34.91 ,$14.35 ,$27.27 ,$56.58 ,$35.88 ,$14.35 ,$58.65 ,$62.10 ,$14.35 ,$51.75 ,$48.30 ,$51.06 ,$51.06 ,$35.88 ,$58.65 ,$14.35 ,$14.35 ,$48.37 ,$14.35 ,$28.70 , N/A ,$58.65 ,$30.85 ,$19.32 ,$62.10 ,$28.70 ,$14.35 ,$44.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101382,84206,HC PROINSULIN-90,301,1 ,$100.00 ,$65.00 ,$26.69 ,$100.00 ,$65.00 ,$26.69 ,$28.00 ,$50.60 ,$26.69 ,$57.50 ,$26.69 ,$50.59 ,$26.69 ,$50.71 ,$82.00 ,$66.73 ,$26.69 ,$85.00 ,$90.00 ,$26.69 ,$75.00 ,$70.00 ,$74.00 ,$74.00 ,$66.73 ,$85.00 ,$26.69 ,$26.69 ,$70.10 ,$26.69 ,$41.60 , N/A ,$85.00 ,$57.38 ,$28.00 ,$90.00 ,$53.38 ,$26.69 ,$65.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101383,84207,HC VITAMIN B6-90,301,1 ,$180.00 ,$117.00 ,$28.10 ,$180.00 ,$117.00 ,$28.10 ,$50.40 ,$91.08 ,$28.10 ,$103.50 ,$28.10 ,$91.06 ,$28.10 ,$53.39 ,$147.60 ,$70.25 ,$28.10 ,$153.00 ,$162.00 ,$28.10 ,$135.00 ,$126.00 ,$133.20 ,$133.20 ,$70.25 ,$153.00 ,$28.10 ,$28.10 ,$126.18 ,$28.10 ,$74.88 , N/A ,$153.00 ,$60.42 ,$50.40 ,$162.00 ,$56.20 ,$28.10 ,$117.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101386,84238,HC RECEPTOR ASSAY NON ENDO-90,301,1 ,$233.00 ,$151.45 ,$36.57 ,$233.00 ,$151.45 ,$36.57 ,$65.24 ,$117.90 ,$36.57 ,$133.98 ,$36.57 ,$117.87 ,$36.57 ,$69.48 ,$191.06 ,$91.43 ,$36.57 ,$198.05 ,$209.70 ,$36.57 ,$174.75 ,$163.10 ,$172.42 ,$172.42 ,$91.43 ,$198.05 ,$36.57 ,$36.57 ,$163.33 ,$36.57 ,$96.93 , N/A ,$198.05 ,$78.63 ,$65.24 ,$209.70 ,$73.14 ,$36.57 ,$151.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101387,84244,HC RENIN-90,301,1 ,$233.00 ,$151.45 ,$21.99 ,$233.00 ,$151.45 ,$21.99 ,$65.24 ,$117.90 ,$21.99 ,$133.98 ,$21.99 ,$117.87 ,$21.99 ,$41.78 ,$191.06 ,$54.98 ,$21.99 ,$198.05 ,$209.70 ,$21.99 ,$174.75 ,$163.10 ,$172.42 ,$172.42 ,$54.98 ,$198.05 ,$21.99 ,$21.99 ,$163.33 ,$21.99 ,$96.93 , N/A ,$198.05 ,$47.28 ,$65.24 ,$209.70 ,$43.98 ,$21.99 ,$151.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101388,84255,HC SELENIUM-90,301,1 ,$224.00 ,$145.60 ,$25.53 ,$224.00 ,$145.60 ,$25.53 ,$62.72 ,$113.34 ,$25.53 ,$128.80 ,$25.53 ,$113.32 ,$25.53 ,$48.51 ,$183.68 ,$63.83 ,$25.53 ,$190.40 ,$201.60 ,$25.53 ,$168.00 ,$156.80 ,$165.76 ,$165.76 ,$63.83 ,$190.40 ,$25.53 ,$25.53 ,$157.02 ,$25.53 ,$93.18 , N/A ,$190.40 ,$54.89 ,$62.72 ,$201.60 ,$51.06 ,$25.53 ,$145.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101389,84252,HC VITAMIN B-2 (RIBOFLAVIN)-90,301,1 ,$87.00 ,$56.55 ,$20.24 ,$87.00 ,$56.55 ,$20.24 ,$24.36 ,$44.02 ,$20.24 ,$50.03 ,$20.24 ,$44.01 ,$20.24 ,$38.46 ,$71.34 ,$50.60 ,$20.24 ,$73.95 ,$78.30 ,$20.24 ,$65.25 ,$60.90 ,$64.38 ,$64.38 ,$50.60 ,$73.95 ,$20.24 ,$20.24 ,$60.99 ,$20.24 ,$36.19 , N/A ,$73.95 ,$43.52 ,$24.36 ,$78.30 ,$40.48 ,$20.24 ,$56.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101390,84270,HC SEX HORMONE BIND GLOB-90,301,1 ,$81.00 ,$52.65 ,$21.73 ,$81.00 ,$52.65 ,$21.73 ,$22.68 ,$40.99 ,$21.73 ,$46.58 ,$21.73 ,$40.98 ,$21.73 ,$41.29 ,$66.42 ,$54.33 ,$21.73 ,$68.85 ,$72.90 ,$21.73 ,$60.75 ,$56.70 ,$59.94 ,$59.94 ,$54.33 ,$68.85 ,$21.73 ,$21.73 ,$56.78 ,$21.73 ,$33.70 , N/A ,$68.85 ,$46.72 ,$22.68 ,$72.90 ,$43.46 ,$21.73 ,$52.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101392,84260,HC SEROTONIN-90,301,1 ,$72.00 ,$46.80 ,$20.16 ,$77.45 ,$46.80 ,$30.98 ,$20.16 ,$36.43 ,$30.98 ,$41.40 ,$30.98 ,$36.42 ,$30.98 ,$58.86 ,$59.04 ,$77.45 ,$30.98 ,$61.20 ,$64.80 ,$30.98 ,$54.00 ,$50.40 ,$53.28 ,$53.28 ,$72.00 ,$61.20 ,$30.98 ,$30.98 ,$50.47 ,$30.98 ,$29.95 , N/A ,$61.20 ,$66.61 ,$20.16 ,$64.80 ,$61.96 ,$30.98 ,$46.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101394,84300,HC SODIUM URINE-90,301,1 ,$93.00 ,$60.45 ,$5.06 ,$93.00 ,$60.45 ,$5.06 ,$26.04 ,$47.06 ,$5.06 ,$53.48 ,$5.06 ,$47.05 ,$5.06 ,$9.61 ,$76.26 ,$12.65 ,$5.06 ,$79.05 ,$83.70 ,$5.06 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$12.65 ,$79.05 ,$5.06 ,$5.06 ,$65.19 ,$5.06 ,$38.69 , N/A ,$79.05 ,$10.88 ,$26.04 ,$83.70 ,$10.12 ,$5.06 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101395,84302,HC SODIUM OTHER FLUID-90,301,1 ,$16.00 ,$10.40 ,$4.48 ,$16.00 ,$10.40 ,$4.86 ,$4.48 ,$8.10 ,$4.86 ,$9.20 ,$4.86 ,$8.09 ,$4.86 ,$9.23 ,$13.12 ,$12.15 ,$4.86 ,$13.60 ,$14.40 ,$4.86 ,$12.00 ,$11.20 ,$11.84 ,$11.84 ,$12.15 ,$13.60 ,$4.86 ,$4.86 ,$11.22 ,$4.86 ,$6.66 , N/A ,$13.60 ,$10.45 ,$4.48 ,$14.40 ,$9.72 ,$4.86 ,$10.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101396,84305,HC SOMATOMEDIN-90,301,1 ,$248.00 ,$161.20 ,$21.26 ,$248.00 ,$161.20 ,$21.26 ,$69.44 ,$125.49 ,$21.26 ,$142.60 ,$21.26 ,$125.46 ,$21.26 ,$40.39 ,$203.36 ,$53.15 ,$21.26 ,$210.80 ,$223.20 ,$21.26 ,$186.00 ,$173.60 ,$183.52 ,$183.52 ,$53.15 ,$210.80 ,$21.26 ,$21.26 ,$173.85 ,$21.26 ,$103.17 , N/A ,$210.80 ,$45.71 ,$69.44 ,$223.20 ,$42.52 ,$21.26 ,$161.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101398,84311,HC SPECTROPHOTOMETRY-90,301,1 ,$78.00 ,$50.70 ,$8.10 ,$78.00 ,$50.70 ,$8.10 ,$21.84 ,$39.47 ,$8.10 ,$44.85 ,$8.10 ,$39.46 ,$8.10 ,$15.39 ,$63.96 ,$20.25 ,$8.10 ,$66.30 ,$70.20 ,$8.10 ,$58.50 ,$54.60 ,$57.72 ,$57.72 ,$20.25 ,$66.30 ,$8.10 ,$8.10 ,$54.68 ,$8.10 ,$32.45 , N/A ,$66.30 ,$17.42 ,$21.84 ,$70.20 ,$16.20 ,$8.10 ,$50.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101402,84376,HC SUGARS SINGLE QL-90,301,1 ,$4.80 ,$3.12 ,$1.34 ,$12.00 ,$3.12 ,$4.80 ,$1.34 ,$2.43 ,$4.80 ,$2.76 ,$4.80 ,$2.43 ,$4.80 ,$4.80 ,$3.94 ,$12.00 ,$4.80 ,$4.08 ,$4.32 ,$4.80 ,$3.60 ,$3.36 ,$3.55 ,$3.55 ,$4.80 ,$4.08 ,$4.80 ,$4.80 ,$3.36 ,$4.80 ,$2.00 , N/A ,$4.08 ,$10.32 ,$1.34 ,$4.32 ,$4.80 ,$4.80 ,$3.12 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101405,84392,HC SULFATE URINE-90,301,1 ,$432.00 ,$280.80 ,$5.49 ,$432.00 ,$280.80 ,$5.49 ,$120.96 ,$218.59 ,$5.49 ,$248.40 ,$5.49 ,$218.55 ,$5.49 ,$10.43 ,$354.24 ,$13.73 ,$5.49 ,$367.20 ,$388.80 ,$5.49 ,$324.00 ,$302.40 ,$319.68 ,$319.68 ,$13.73 ,$367.20 ,$5.49 ,$5.49 ,$302.83 ,$5.49 ,$179.71 , N/A ,$367.20 ,$11.80 ,$120.96 ,$388.80 ,$10.98 ,$5.49 ,$280.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101406,84402,HC TESTOSTERONE FREE-90,301,1 ,$181.00 ,$117.65 ,$25.47 ,$181.00 ,$117.65 ,$25.47 ,$50.68 ,$91.59 ,$25.47 ,$104.08 ,$25.47 ,$91.57 ,$25.47 ,$48.39 ,$148.42 ,$63.68 ,$25.47 ,$153.85 ,$162.90 ,$25.47 ,$135.75 ,$126.70 ,$133.94 ,$133.94 ,$63.68 ,$153.85 ,$25.47 ,$25.47 ,$126.88 ,$25.47 ,$75.30 , N/A ,$153.85 ,$54.76 ,$50.68 ,$162.90 ,$50.94 ,$25.47 ,$117.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101407,84403,HC TESTOSTERONE TOTAL-90,301,1 ,$191.00 ,$124.15 ,$25.81 ,$191.00 ,$124.15 ,$25.81 ,$53.48 ,$96.65 ,$25.81 ,$109.83 ,$25.81 ,$96.63 ,$25.81 ,$49.04 ,$156.62 ,$64.53 ,$25.81 ,$162.35 ,$171.90 ,$25.81 ,$143.25 ,$133.70 ,$141.34 ,$141.34 ,$64.53 ,$162.35 ,$25.81 ,$25.81 ,$133.89 ,$25.81 ,$79.46 , N/A ,$162.35 ,$55.49 ,$53.48 ,$171.90 ,$51.62 ,$25.81 ,$124.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101408,84425,HC VITAMIN B1-90,301,1 ,$234.00 ,$152.10 ,$21.23 ,$234.00 ,$152.10 ,$21.23 ,$65.52 ,$118.40 ,$21.23 ,$134.55 ,$21.23 ,$118.38 ,$21.23 ,$40.34 ,$191.88 ,$53.08 ,$21.23 ,$198.90 ,$210.60 ,$21.23 ,$175.50 ,$163.80 ,$173.16 ,$173.16 ,$53.08 ,$198.90 ,$21.23 ,$21.23 ,$164.03 ,$21.23 ,$97.34 , N/A ,$198.90 ,$45.64 ,$65.52 ,$210.60 ,$42.46 ,$21.23 ,$152.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101409,84430,HC THIOCYANATE-90,301,1 ,$21.84 ,$14.20 ,$6.12 ,$29.08 ,$14.20 ,$11.63 ,$6.12 ,$11.05 ,$11.63 ,$12.56 ,$11.63 ,$11.05 ,$11.63 ,$21.84 ,$17.91 ,$29.08 ,$11.63 ,$18.56 ,$19.66 ,$11.63 ,$16.38 ,$15.29 ,$16.16 ,$16.16 ,$21.84 ,$18.56 ,$11.63 ,$11.63 ,$15.31 ,$11.63 ,$9.09 , N/A ,$18.56 ,$25.00 ,$6.12 ,$19.66 ,$21.84 ,$11.63 ,$14.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101410,84432,HC THYROGLOBULIN-90,301,1 ,$57.00 ,$37.05 ,$15.96 ,$57.00 ,$37.05 ,$16.06 ,$15.96 ,$28.84 ,$16.06 ,$32.78 ,$16.06 ,$28.84 ,$16.06 ,$30.51 ,$46.74 ,$40.15 ,$16.06 ,$48.45 ,$51.30 ,$16.06 ,$42.75 ,$39.90 ,$42.18 ,$42.18 ,$40.15 ,$48.45 ,$16.06 ,$16.06 ,$39.96 ,$16.06 ,$23.71 , N/A ,$48.45 ,$34.53 ,$15.96 ,$51.30 ,$32.12 ,$16.06 ,$37.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101415,84442,HC THYROXINE BIND GLOB-90,301,1 ,$127.00 ,$82.55 ,$14.78 ,$127.00 ,$82.55 ,$14.78 ,$35.56 ,$64.26 ,$14.78 ,$73.03 ,$14.78 ,$64.25 ,$14.78 ,$28.08 ,$104.14 ,$36.95 ,$14.78 ,$107.95 ,$114.30 ,$14.78 ,$95.25 ,$88.90 ,$93.98 ,$93.98 ,$36.95 ,$107.95 ,$14.78 ,$14.78 ,$89.03 ,$14.78 ,$52.83 , N/A ,$107.95 ,$31.78 ,$35.56 ,$114.30 ,$29.56 ,$14.78 ,$82.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101417,84445,HC THYROID STIM IMMUNO GLOB-90,301,1 ,$359.00 ,$233.35 ,$50.86 ,$359.00 ,$233.35 ,$50.86 ,$100.52 ,$181.65 ,$50.86 ,$206.43 ,$50.86 ,$181.62 ,$50.86 ,$96.63 ,$294.38 ,$127.15 ,$50.86 ,$305.15 ,$323.10 ,$50.86 ,$269.25 ,$251.30 ,$265.66 ,$265.66 ,$127.15 ,$305.15 ,$50.86 ,$50.86 ,$251.66 ,$50.86 ,$149.34 , N/A ,$305.15 ,$109.35 ,$100.52 ,$323.10 ,$101.72 ,$50.86 ,$233.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101418,84446,HC VITAMIN E-90,301,1 ,$95.00 ,$61.75 ,$14.18 ,$95.00 ,$61.75 ,$14.18 ,$26.60 ,$48.07 ,$14.18 ,$54.63 ,$14.18 ,$48.06 ,$14.18 ,$26.94 ,$77.90 ,$35.45 ,$14.18 ,$80.75 ,$85.50 ,$14.18 ,$71.25 ,$66.50 ,$70.30 ,$70.30 ,$35.45 ,$80.75 ,$14.18 ,$14.18 ,$66.60 ,$14.18 ,$39.52 , N/A ,$80.75 ,$30.49 ,$26.60 ,$85.50 ,$28.36 ,$14.18 ,$61.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101422,84479,HC T3 UPTAKE-90,301,1 ,$65.00 ,$42.25 ,$6.47 ,$65.00 ,$42.25 ,$6.47 ,$18.20 ,$32.89 ,$6.47 ,$37.38 ,$6.47 ,$32.88 ,$6.47 ,$12.29 ,$53.30 ,$16.18 ,$6.47 ,$55.25 ,$58.50 ,$6.47 ,$48.75 ,$45.50 ,$48.10 ,$48.10 ,$16.18 ,$55.25 ,$6.47 ,$6.47 ,$45.57 ,$6.47 ,$27.04 , N/A ,$55.25 ,$13.91 ,$18.20 ,$58.50 ,$12.94 ,$6.47 ,$42.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101423,84480,HC T3 TOTAL-90,301,1 ,$151.00 ,$98.15 ,$14.18 ,$151.00 ,$98.15 ,$14.18 ,$42.28 ,$76.41 ,$14.18 ,$86.83 ,$14.18 ,$76.39 ,$14.18 ,$26.94 ,$123.82 ,$35.45 ,$14.18 ,$128.35 ,$135.90 ,$14.18 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$35.45 ,$128.35 ,$14.18 ,$14.18 ,$105.85 ,$14.18 ,$62.82 , N/A ,$128.35 ,$30.49 ,$42.28 ,$135.90 ,$28.36 ,$14.18 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101425,84482,HC T3 REVERSE-90,301,1 ,$384.00 ,$249.60 ,$15.76 ,$384.00 ,$249.60 ,$15.76 ,$107.52 ,$194.30 ,$15.76 ,$220.80 ,$15.76 ,$194.27 ,$15.76 ,$29.94 ,$314.88 ,$39.40 ,$15.76 ,$326.40 ,$345.60 ,$15.76 ,$288.00 ,$268.80 ,$284.16 ,$284.16 ,$39.40 ,$326.40 ,$15.76 ,$15.76 ,$269.18 ,$15.76 ,$159.74 , N/A ,$326.40 ,$33.88 ,$107.52 ,$345.60 ,$31.52 ,$15.76 ,$249.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101434,84560,HC URIC ACID OTH SRC-90,301,1 ,$172.00 ,$111.80 ,$5.08 ,$172.00 ,$111.80 ,$5.08 ,$48.16 ,$87.03 ,$5.08 ,$98.90 ,$5.08 ,$87.01 ,$5.08 ,$9.65 ,$141.04 ,$12.70 ,$5.08 ,$146.20 ,$154.80 ,$5.08 ,$129.00 ,$120.40 ,$127.28 ,$127.28 ,$12.70 ,$146.20 ,$5.08 ,$5.08 ,$120.57 ,$5.08 ,$71.55 , N/A ,$146.20 ,$10.92 ,$48.16 ,$154.80 ,$10.16 ,$5.08 ,$111.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101435,84585,HC VANILLYLMAND AC (VMA)-90,301,1 ,$98.00 ,$63.70 ,$15.50 ,$98.00 ,$63.70 ,$15.50 ,$27.44 ,$49.59 ,$15.50 ,$56.35 ,$15.50 ,$49.58 ,$15.50 ,$29.45 ,$80.36 ,$38.75 ,$15.50 ,$83.30 ,$88.20 ,$15.50 ,$73.50 ,$68.60 ,$72.52 ,$72.52 ,$38.75 ,$83.30 ,$15.50 ,$15.50 ,$68.70 ,$15.50 ,$40.77 , N/A ,$83.30 ,$33.33 ,$27.44 ,$88.20 ,$31.00 ,$15.50 ,$63.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101436,84586,HC VASOACTIVE INTEST PEPTIDE-90,301,1 ,$158.00 ,$102.70 ,$35.33 ,$158.00 ,$102.70 ,$35.33 ,$44.24 ,$79.95 ,$35.33 ,$90.85 ,$35.33 ,$79.93 ,$35.33 ,$67.13 ,$129.56 ,$88.33 ,$35.33 ,$134.30 ,$142.20 ,$35.33 ,$118.50 ,$110.60 ,$116.92 ,$116.92 ,$88.33 ,$134.30 ,$35.33 ,$35.33 ,$110.76 ,$35.33 ,$65.73 , N/A ,$134.30 ,$75.96 ,$44.24 ,$142.20 ,$70.66 ,$35.33 ,$102.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101438,84590,HC VITAMIN A-90,301,1 ,$67.00 ,$43.55 ,$11.61 ,$67.00 ,$43.55 ,$11.61 ,$18.76 ,$33.90 ,$11.61 ,$38.53 ,$11.61 ,$33.90 ,$11.61 ,$22.06 ,$54.94 ,$29.03 ,$11.61 ,$56.95 ,$60.30 ,$11.61 ,$50.25 ,$46.90 ,$49.58 ,$49.58 ,$29.03 ,$56.95 ,$11.61 ,$11.61 ,$46.97 ,$11.61 ,$27.87 , N/A ,$56.95 ,$24.96 ,$18.76 ,$60.30 ,$23.22 ,$11.61 ,$43.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101440,84597,HC VITAMIN K-90,301,1 ,$107.00 ,$69.55 ,$13.72 ,$107.00 ,$69.55 ,$13.72 ,$29.96 ,$54.14 ,$13.72 ,$61.53 ,$13.72 ,$54.13 ,$13.72 ,$26.07 ,$87.74 ,$34.30 ,$13.72 ,$90.95 ,$96.30 ,$13.72 ,$80.25 ,$74.90 ,$79.18 ,$79.18 ,$34.30 ,$90.95 ,$13.72 ,$13.72 ,$75.01 ,$13.72 ,$44.51 , N/A ,$90.95 ,$29.50 ,$29.96 ,$96.30 ,$27.44 ,$13.72 ,$69.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101441,84600,HC VOLATILES-90,301,1 ,$58.00 ,$37.70 ,$16.24 ,$58.00 ,$37.70 ,$17.11 ,$16.24 ,$29.35 ,$17.11 ,$33.35 ,$17.11 ,$29.34 ,$17.11 ,$32.51 ,$47.56 ,$42.78 ,$17.11 ,$49.30 ,$52.20 ,$17.11 ,$43.50 ,$40.60 ,$42.92 ,$42.92 ,$42.78 ,$49.30 ,$17.11 ,$17.11 ,$40.66 ,$17.11 ,$24.13 , N/A ,$49.30 ,$36.79 ,$16.24 ,$52.20 ,$34.22 ,$17.11 ,$37.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101442,84630,HC ZINC-90,301,1 ,$131.00 ,$85.15 ,$11.39 ,$131.00 ,$85.15 ,$11.39 ,$36.68 ,$66.29 ,$11.39 ,$75.33 ,$11.39 ,$66.27 ,$11.39 ,$21.64 ,$107.42 ,$28.48 ,$11.39 ,$111.35 ,$117.90 ,$11.39 ,$98.25 ,$91.70 ,$96.94 ,$96.94 ,$28.48 ,$111.35 ,$11.39 ,$11.39 ,$91.83 ,$11.39 ,$54.50 , N/A ,$111.35 ,$24.49 ,$36.68 ,$117.90 ,$22.78 ,$11.39 ,$85.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101443,84681,HC C PEPTIDE-90,301,1 ,$144.00 ,$93.60 ,$20.81 ,$144.00 ,$93.60 ,$20.81 ,$40.32 ,$72.86 ,$20.81 ,$82.80 ,$20.81 ,$72.85 ,$20.81 ,$39.54 ,$118.08 ,$52.03 ,$20.81 ,$122.40 ,$129.60 ,$20.81 ,$108.00 ,$100.80 ,$106.56 ,$106.56 ,$52.03 ,$122.40 ,$20.81 ,$20.81 ,$100.94 ,$20.81 ,$59.90 , N/A ,$122.40 ,$44.74 ,$40.32 ,$129.60 ,$41.62 ,$20.81 ,$93.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101444,84702,HC HCG QN-90,301,1 ,$193.00 ,$125.45 ,$15.05 ,$193.00 ,$125.45 ,$15.05 ,$54.04 ,$97.66 ,$15.05 ,$110.98 ,$15.05 ,$97.64 ,$15.05 ,$28.60 ,$158.26 ,$37.63 ,$15.05 ,$164.05 ,$173.70 ,$15.05 ,$144.75 ,$135.10 ,$142.82 ,$142.82 ,$37.63 ,$164.05 ,$15.05 ,$15.05 ,$135.29 ,$15.05 ,$80.29 , N/A ,$164.05 ,$32.36 ,$54.04 ,$173.70 ,$30.10 ,$15.05 ,$125.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101455,G0480,HC DRUG SCRN DEFNT 1-7 CLS T1-90,301,1 ,$56.00 ,$36.40 ,$15.68 ,$140.00 ,$36.40 ,$56.00 ,$15.68 ,$28.34 ,$56.00 ,$32.20 ,$56.00 ,$28.33 ,$56.00 ,$56.00 ,$45.92 ,$140.00 ,$56.00 ,$47.60 ,$50.40 ,$56.00 ,$42.00 ,$39.20 ,$41.44 ,$41.44 ,$56.00 ,$47.60 ,$56.00 ,$56.00 ,$39.26 ,$56.00 ,$23.30 , N/A ,$47.60 ,$120.40 ,$15.68 ,$50.40 ,$56.00 ,$56.00 ,$36.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101463,G0483,HC DRUG SCRN DEFINT 22+ CLASS-90,301,1 ,$244.00 ,$158.60 ,$68.32 ,$610.00 ,$158.60 ,$244.00 ,$68.32 ,$123.46 ,$244.00 ,$140.30 ,$244.00 ,$123.44 ,$244.00 ,$244.00 ,$200.08 ,$610.00 ,$244.00 ,$207.40 ,$219.60 ,$244.00 ,$183.00 ,$170.80 ,$180.56 ,$180.56 ,$244.00 ,$207.40 ,$244.00 ,$244.00 ,$171.04 ,$244.00 ,$101.50 , N/A ,$207.40 ,$524.60 ,$68.32 ,$219.60 ,$244.00 ,$244.00 ,$158.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101464,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$46.00 ,$29.90 ,$4.23 ,$46.00 ,$29.90 ,$4.23 ,$12.88 ,$23.28 ,$4.23 ,$26.45 ,$4.23 ,$23.27 ,$4.23 ,$8.04 ,$37.72 ,$10.58 ,$4.23 ,$39.10 ,$41.40 ,$4.23 ,$34.50 ,$32.20 ,$34.04 ,$34.04 ,$10.58 ,$39.10 ,$4.23 ,$4.23 ,$32.25 ,$4.23 ,$19.14 , N/A ,$39.10 ,$9.09 ,$12.88 ,$41.40 ,$8.46 ,$4.23 ,$29.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101465,83921,HC ORGANIC ACIDS QN SINGLE-90,301,1 ,$376.00 ,$244.40 ,$21.21 ,$376.00 ,$244.40 ,$21.21 ,$105.28 ,$190.26 ,$21.21 ,$216.20 ,$21.21 ,$190.22 ,$21.21 ,$40.30 ,$308.32 ,$53.03 ,$21.21 ,$319.60 ,$338.40 ,$21.21 ,$282.00 ,$263.20 ,$278.24 ,$278.24 ,$53.03 ,$319.60 ,$21.21 ,$21.21 ,$263.58 ,$21.21 ,$156.42 , N/A ,$319.60 ,$45.60 ,$105.28 ,$338.40 ,$42.42 ,$21.21 ,$244.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101509,82330,HC CALCIUM IONIZED STAT -90,301,1 ,$158.00 ,$102.70 ,$13.68 ,$158.00 ,$102.70 ,$13.68 ,$44.24 ,$79.95 ,$13.68 ,$90.85 ,$13.68 ,$79.93 ,$13.68 ,$25.99 ,$129.56 ,$34.20 ,$13.68 ,$134.30 ,$142.20 ,$13.68 ,$118.50 ,$110.60 ,$116.92 ,$116.92 ,$34.20 ,$134.30 ,$13.68 ,$13.68 ,$110.76 ,$13.68 ,$65.73 , N/A ,$134.30 ,$29.41 ,$44.24 ,$142.20 ,$27.36 ,$13.68 ,$102.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101534,80377,HC PANEL HYPOGLYCEMIC QL-90,301,1 ,$185.00 ,$120.25 ,$51.80 ,$185.00 ,$120.25 , N/A ,$51.80 ,$93.61 , N/A ,$106.38 , N/A ,$93.59 , N/A , N/A ,$151.70 , N/A , N/A ,$157.25 ,$166.50 , N/A ,$138.75 ,$129.50 ,$136.90 ,$136.90 , N/A ,$157.25 , N/A , N/A ,$129.69 , N/A ,$76.96 , N/A ,$157.25 , N/A ,$51.80 ,$166.50 , N/A , N/A ,$120.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101540,84163,HC PLASMA PROTEIN-A PREGNANCY ASSOCIATED-90,301,1 ,$164.00 ,$106.60 ,$15.05 ,$164.00 ,$106.60 ,$15.05 ,$45.92 ,$82.98 ,$15.05 ,$94.30 ,$15.05 ,$82.97 ,$15.05 ,$28.60 ,$134.48 ,$37.63 ,$15.05 ,$139.40 ,$147.60 ,$15.05 ,$123.00 ,$114.80 ,$121.36 ,$121.36 ,$37.63 ,$139.40 ,$15.05 ,$15.05 ,$114.96 ,$15.05 ,$68.22 , N/A ,$139.40 ,$32.36 ,$45.92 ,$147.60 ,$30.10 ,$15.05 ,$106.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101543,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$353.00 ,$229.45 ,$47.63 ,$353.00 ,$229.45 ,$47.63 ,$98.84 ,$178.62 ,$47.63 ,$202.98 ,$47.63 ,$178.58 ,$47.63 ,$90.50 ,$289.46 ,$119.08 ,$47.63 ,$300.05 ,$317.70 ,$47.63 ,$264.75 ,$247.10 ,$261.22 ,$261.22 ,$119.08 ,$300.05 ,$47.63 ,$47.63 ,$247.45 ,$47.63 ,$146.85 , N/A ,$300.05 ,$102.40 ,$98.84 ,$317.70 ,$95.26 ,$47.63 ,$229.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101547,80170,HC GENTAMICIN,301,1 ,$197.00 ,$128.05 ,$16.38 ,$197.00 ,$128.05 ,$16.38 ,$55.16 ,$99.68 ,$16.38 ,$113.28 ,$16.38 ,$99.66 ,$16.38 ,$31.12 ,$161.54 ,$40.95 ,$16.38 ,$167.45 ,$177.30 ,$16.38 ,$147.75 ,$137.90 ,$145.78 ,$145.78 ,$40.95 ,$167.45 ,$16.38 ,$16.38 ,$138.10 ,$16.38 ,$81.95 , N/A ,$167.45 ,$35.22 ,$55.16 ,$177.30 ,$32.76 ,$16.38 ,$128.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101549,80184,HC PHENOBARBITAL,301,1 ,$142.00 ,$92.30 ,$15.30 ,$142.00 ,$92.30 ,$15.30 ,$39.76 ,$71.85 ,$15.30 ,$81.65 ,$15.30 ,$71.84 ,$15.30 ,$29.07 ,$116.44 ,$38.25 ,$15.30 ,$120.70 ,$127.80 ,$15.30 ,$106.50 ,$99.40 ,$105.08 ,$105.08 ,$38.25 ,$120.70 ,$15.30 ,$15.30 ,$99.54 ,$15.30 ,$59.07 , N/A ,$120.70 ,$32.90 ,$39.76 ,$127.80 ,$30.60 ,$15.30 ,$92.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101551,80198,HC THEOPHYLLINE,301,1 ,$155.00 ,$100.75 ,$14.14 ,$155.00 ,$100.75 ,$14.14 ,$43.40 ,$78.43 ,$14.14 ,$89.13 ,$14.14 ,$78.41 ,$14.14 ,$26.87 ,$127.10 ,$35.35 ,$14.14 ,$131.75 ,$139.50 ,$14.14 ,$116.25 ,$108.50 ,$114.70 ,$114.70 ,$35.35 ,$131.75 ,$14.14 ,$14.14 ,$108.66 ,$14.14 ,$64.48 , N/A ,$131.75 ,$30.40 ,$43.40 ,$139.50 ,$28.28 ,$14.14 ,$100.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101552,80200,HC TOBRAMYCIN,301,1 ,$154.00 ,$100.10 ,$16.13 ,$154.00 ,$100.10 ,$16.13 ,$43.12 ,$77.92 ,$16.13 ,$88.55 ,$16.13 ,$77.91 ,$16.13 ,$30.65 ,$126.28 ,$40.33 ,$16.13 ,$130.90 ,$138.60 ,$16.13 ,$115.50 ,$107.80 ,$113.96 ,$113.96 ,$40.33 ,$130.90 ,$16.13 ,$16.13 ,$107.95 ,$16.13 ,$64.06 , N/A ,$130.90 ,$34.68 ,$43.12 ,$138.60 ,$32.26 ,$16.13 ,$100.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101556,82042,HC ALBUMIN OTHER SOURCE,301,1 ,$49.00 ,$31.85 ,$7.78 ,$49.00 ,$31.85 ,$7.78 ,$13.72 ,$24.79 ,$7.78 ,$28.18 ,$7.78 ,$24.79 ,$7.78 ,$14.78 ,$40.18 ,$19.45 ,$7.78 ,$41.65 ,$44.10 ,$7.78 ,$36.75 ,$34.30 ,$36.26 ,$36.26 ,$19.45 ,$41.65 ,$7.78 ,$7.78 ,$34.35 ,$7.78 ,$20.38 , N/A ,$41.65 ,$16.73 ,$13.72 ,$44.10 ,$15.56 ,$7.78 ,$31.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101559,82150,HC AMYLASE,301,1 ,$111.00 ,$72.15 ,$6.48 ,$111.00 ,$72.15 ,$6.48 ,$31.08 ,$56.17 ,$6.48 ,$63.83 ,$6.48 ,$56.15 ,$6.48 ,$12.31 ,$91.02 ,$16.20 ,$6.48 ,$94.35 ,$99.90 ,$6.48 ,$83.25 ,$77.70 ,$82.14 ,$82.14 ,$16.20 ,$94.35 ,$6.48 ,$6.48 ,$77.81 ,$6.48 ,$46.18 , N/A ,$94.35 ,$13.93 ,$31.08 ,$99.90 ,$12.96 ,$6.48 ,$72.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101565,82310,HC CALCIUM,301,1 ,$71.00 ,$46.15 ,$5.16 ,$71.00 ,$46.15 ,$5.16 ,$19.88 ,$35.93 ,$5.16 ,$40.83 ,$5.16 ,$35.92 ,$5.16 ,$9.80 ,$58.22 ,$12.90 ,$5.16 ,$60.35 ,$63.90 ,$5.16 ,$53.25 ,$49.70 ,$52.54 ,$52.54 ,$12.90 ,$60.35 ,$5.16 ,$5.16 ,$49.77 ,$5.16 ,$29.54 , N/A ,$60.35 ,$11.09 ,$19.88 ,$63.90 ,$10.32 ,$5.16 ,$46.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101568,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$174.00 ,$113.10 ,$18.96 ,$174.00 ,$113.10 ,$18.96 ,$48.72 ,$88.04 ,$18.96 ,$100.05 ,$18.96 ,$88.03 ,$18.96 ,$36.02 ,$142.68 ,$47.40 ,$18.96 ,$147.90 ,$156.60 ,$18.96 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$47.40 ,$147.90 ,$18.96 ,$18.96 ,$121.97 ,$18.96 ,$72.38 , N/A ,$147.90 ,$40.76 ,$48.72 ,$156.60 ,$37.92 ,$18.96 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101570,82465,HC CHOLESTEROL,301,1 ,$105.00 ,$68.25 ,$4.35 ,$105.00 ,$68.25 ,$4.35 ,$29.40 ,$53.13 ,$4.35 ,$60.38 ,$4.35 ,$53.12 ,$4.35 ,$8.27 ,$86.10 ,$10.88 ,$4.35 ,$89.25 ,$94.50 ,$4.35 ,$78.75 ,$73.50 ,$77.70 ,$77.70 ,$10.88 ,$89.25 ,$4.35 ,$4.35 ,$73.61 ,$4.35 ,$43.68 , N/A ,$89.25 ,$9.35 ,$29.40 ,$94.50 ,$8.70 ,$4.35 ,$68.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101571,82533,HC CORTISOL TOTAL,301,1 ,$29.00 ,$18.85 ,$8.12 ,$40.75 ,$18.85 ,$16.30 ,$8.12 ,$14.67 ,$16.30 ,$16.68 ,$16.30 ,$14.67 ,$16.30 ,$29.00 ,$23.78 ,$40.75 ,$16.30 ,$24.65 ,$26.10 ,$16.30 ,$21.75 ,$20.30 ,$21.46 ,$21.46 ,$29.00 ,$24.65 ,$16.30 ,$16.30 ,$20.33 ,$16.30 ,$12.06 , N/A ,$24.65 ,$35.05 ,$8.12 ,$26.10 ,$29.00 ,$16.30 ,$18.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101572,82570,HC CREATININE OTH SOURCE,301,1 ,$85.00 ,$55.25 ,$5.18 ,$85.00 ,$55.25 ,$5.18 ,$23.80 ,$43.01 ,$5.18 ,$48.88 ,$5.18 ,$43.00 ,$5.18 ,$9.84 ,$69.70 ,$12.95 ,$5.18 ,$72.25 ,$76.50 ,$5.18 ,$63.75 ,$59.50 ,$62.90 ,$62.90 ,$12.95 ,$72.25 ,$5.18 ,$5.18 ,$59.59 ,$5.18 ,$35.36 , N/A ,$72.25 ,$11.14 ,$23.80 ,$76.50 ,$10.36 ,$5.18 ,$55.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101581,82945,HC GLUCOSE BODY FLUID,301,1 ,$13.00 ,$8.45 ,$3.64 ,$13.00 ,$8.45 ,$3.93 ,$3.64 ,$6.58 ,$3.93 ,$7.48 ,$3.93 ,$6.58 ,$3.93 ,$7.47 ,$10.66 ,$9.83 ,$3.93 ,$11.05 ,$11.70 ,$3.93 ,$9.75 ,$9.10 ,$9.62 ,$9.62 ,$9.83 ,$11.05 ,$3.93 ,$3.93 ,$9.11 ,$3.93 ,$5.41 , N/A ,$11.05 ,$8.45 ,$3.64 ,$11.70 ,$7.86 ,$3.93 ,$8.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101585,83001,HC FSH,301,1 ,$81.00 ,$52.65 ,$18.58 ,$81.00 ,$52.65 ,$18.58 ,$22.68 ,$40.99 ,$18.58 ,$46.58 ,$18.58 ,$40.98 ,$18.58 ,$35.30 ,$66.42 ,$46.45 ,$18.58 ,$68.85 ,$72.90 ,$18.58 ,$60.75 ,$56.70 ,$59.94 ,$59.94 ,$46.45 ,$68.85 ,$18.58 ,$18.58 ,$56.78 ,$18.58 ,$33.70 , N/A ,$68.85 ,$39.95 ,$22.68 ,$72.90 ,$37.16 ,$18.58 ,$52.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101586,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$81.00 ,$52.65 ,$18.52 ,$81.00 ,$52.65 ,$18.52 ,$22.68 ,$40.99 ,$18.52 ,$46.58 ,$18.52 ,$40.98 ,$18.52 ,$35.19 ,$66.42 ,$46.30 ,$18.52 ,$68.85 ,$72.90 ,$18.52 ,$60.75 ,$56.70 ,$59.94 ,$59.94 ,$46.30 ,$68.85 ,$18.52 ,$18.52 ,$56.78 ,$18.52 ,$33.70 , N/A ,$68.85 ,$39.82 ,$22.68 ,$72.90 ,$37.04 ,$18.52 ,$52.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101587,83010,HC HAPTOGLOBIN,301,1 ,$147.00 ,$95.55 ,$12.58 ,$147.00 ,$95.55 ,$12.58 ,$41.16 ,$74.38 ,$12.58 ,$84.53 ,$12.58 ,$74.37 ,$12.58 ,$23.90 ,$120.54 ,$31.45 ,$12.58 ,$124.95 ,$132.30 ,$12.58 ,$110.25 ,$102.90 ,$108.78 ,$108.78 ,$31.45 ,$124.95 ,$12.58 ,$12.58 ,$103.05 ,$12.58 ,$61.15 , N/A ,$124.95 ,$27.05 ,$41.16 ,$132.30 ,$25.16 ,$12.58 ,$95.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$104.00 ,$67.60 ,$6.04 ,$104.00 ,$67.60 ,$6.04 ,$29.12 ,$52.62 ,$6.04 ,$59.80 ,$6.04 ,$52.61 ,$6.04 ,$11.48 ,$85.28 ,$15.10 ,$6.04 ,$88.40 ,$93.60 ,$6.04 ,$78.00 ,$72.80 ,$76.96 ,$76.96 ,$15.10 ,$88.40 ,$6.04 ,$6.04 ,$72.90 ,$6.04 ,$43.26 , N/A ,$88.40 ,$12.99 ,$29.12 ,$93.60 ,$12.08 ,$6.04 ,$67.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101598,83930,HC OSMOLALITY BLOOD,301,1 ,$86.00 ,$55.90 ,$6.61 ,$86.00 ,$55.90 ,$6.61 ,$24.08 ,$43.52 ,$6.61 ,$49.45 ,$6.61 ,$43.51 ,$6.61 ,$12.56 ,$70.52 ,$16.53 ,$6.61 ,$73.10 ,$77.40 ,$6.61 ,$64.50 ,$60.20 ,$63.64 ,$63.64 ,$16.53 ,$73.10 ,$6.61 ,$6.61 ,$60.29 ,$6.61 ,$35.78 , N/A ,$73.10 ,$14.21 ,$24.08 ,$77.40 ,$13.22 ,$6.61 ,$55.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101599,83935,HC OSMOLALITY URINE,301,1 ,$78.00 ,$50.70 ,$6.82 ,$78.00 ,$50.70 ,$6.82 ,$21.84 ,$39.47 ,$6.82 ,$44.85 ,$6.82 ,$39.46 ,$6.82 ,$12.96 ,$63.96 ,$17.05 ,$6.82 ,$66.30 ,$70.20 ,$6.82 ,$58.50 ,$54.60 ,$57.72 ,$57.72 ,$17.05 ,$66.30 ,$6.82 ,$6.82 ,$54.68 ,$6.82 ,$32.45 , N/A ,$66.30 ,$14.66 ,$21.84 ,$70.20 ,$13.64 ,$6.82 ,$50.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101600,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$93.00 ,$60.45 ,$26.04 ,$103.20 ,$60.45 ,$41.28 ,$26.04 ,$47.06 ,$41.28 ,$53.48 ,$41.28 ,$47.05 ,$41.28 ,$78.43 ,$76.26 ,$103.20 ,$41.28 ,$79.05 ,$83.70 ,$41.28 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$93.00 ,$79.05 ,$41.28 ,$41.28 ,$65.19 ,$41.28 ,$38.69 , N/A ,$79.05 ,$88.75 ,$26.04 ,$83.70 ,$82.56 ,$41.28 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101602,84105,HC PHOSPHORUS UR,301,1 ,$154.00 ,$100.10 ,$5.78 ,$154.00 ,$100.10 ,$5.78 ,$43.12 ,$77.92 ,$5.78 ,$88.55 ,$5.78 ,$77.91 ,$5.78 ,$10.98 ,$126.28 ,$14.45 ,$5.78 ,$130.90 ,$138.60 ,$5.78 ,$115.50 ,$107.80 ,$113.96 ,$113.96 ,$14.45 ,$130.90 ,$5.78 ,$5.78 ,$107.95 ,$5.78 ,$64.06 , N/A ,$130.90 ,$12.43 ,$43.12 ,$138.60 ,$11.56 ,$5.78 ,$100.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101607,84145,HC PROCALCITONIN (PCT),301,1 ,$325.00 ,$211.25 ,$27.22 ,$325.00 ,$211.25 ,$27.22 ,$91.00 ,$164.45 ,$27.22 ,$186.88 ,$27.22 ,$164.42 ,$27.22 ,$51.72 ,$266.50 ,$68.05 ,$27.22 ,$276.25 ,$292.50 ,$27.22 ,$243.75 ,$227.50 ,$240.50 ,$240.50 ,$68.05 ,$276.25 ,$27.22 ,$27.22 ,$227.83 ,$27.22 ,$135.20 , N/A ,$276.25 ,$58.52 ,$91.00 ,$292.50 ,$54.44 ,$27.22 ,$211.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101608,84146,HC PROLACTIN,301,1 ,$213.00 ,$138.45 ,$19.38 ,$213.00 ,$138.45 ,$19.38 ,$59.64 ,$107.78 ,$19.38 ,$122.48 ,$19.38 ,$107.76 ,$19.38 ,$36.82 ,$174.66 ,$48.45 ,$19.38 ,$181.05 ,$191.70 ,$19.38 ,$159.75 ,$149.10 ,$157.62 ,$157.62 ,$48.45 ,$181.05 ,$19.38 ,$19.38 ,$149.31 ,$19.38 ,$88.61 , N/A ,$181.05 ,$41.67 ,$59.64 ,$191.70 ,$38.76 ,$19.38 ,$138.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101609,84153,HC PSA TOTAL,301,1 ,$174.00 ,$113.10 ,$18.39 ,$174.00 ,$113.10 ,$18.39 ,$48.72 ,$88.04 ,$18.39 ,$100.05 ,$18.39 ,$88.03 ,$18.39 ,$34.94 ,$142.68 ,$45.98 ,$18.39 ,$147.90 ,$156.60 ,$18.39 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$45.98 ,$147.90 ,$18.39 ,$18.39 ,$121.97 ,$18.39 ,$72.38 , N/A ,$147.90 ,$39.54 ,$48.72 ,$156.60 ,$36.78 ,$18.39 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101610,84154,HC PSA FREE,301,1 ,$126.00 ,$81.90 ,$18.39 ,$126.00 ,$81.90 ,$18.39 ,$35.28 ,$63.76 ,$18.39 ,$72.45 ,$18.39 ,$63.74 ,$18.39 ,$34.94 ,$103.32 ,$45.98 ,$18.39 ,$107.10 ,$113.40 ,$18.39 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$45.98 ,$107.10 ,$18.39 ,$18.39 ,$88.33 ,$18.39 ,$52.42 , N/A ,$107.10 ,$39.54 ,$35.28 ,$113.40 ,$36.78 ,$18.39 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101613,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$7.00 ,$4.55 ,$1.96 ,$10.00 ,$4.55 ,$4.00 ,$1.96 ,$3.54 ,$4.00 ,$4.03 ,$4.00 ,$3.54 ,$4.00 ,$7.00 ,$5.74 ,$10.00 ,$4.00 ,$5.95 ,$6.30 ,$4.00 ,$5.25 ,$4.90 ,$5.18 ,$5.18 ,$7.00 ,$5.95 ,$4.00 ,$4.00 ,$4.91 ,$4.00 ,$2.91 , N/A ,$5.95 ,$8.60 ,$1.96 ,$6.30 ,$7.00 ,$4.00 ,$4.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101620,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$120.00 ,$78.00 ,$6.87 ,$120.00 ,$78.00 ,$6.87 ,$33.60 ,$60.72 ,$6.87 ,$69.00 ,$6.87 ,$60.71 ,$6.87 ,$13.05 ,$98.40 ,$17.18 ,$6.87 ,$102.00 ,$108.00 ,$6.87 ,$90.00 ,$84.00 ,$88.80 ,$88.80 ,$17.18 ,$102.00 ,$6.87 ,$6.87 ,$84.12 ,$6.87 ,$49.92 , N/A ,$102.00 ,$14.77 ,$33.60 ,$108.00 ,$13.74 ,$6.87 ,$78.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101622,84466,HC TRANSFERRIN,301,1 ,$123.00 ,$79.95 ,$12.76 ,$123.00 ,$79.95 ,$12.76 ,$34.44 ,$62.24 ,$12.76 ,$70.73 ,$12.76 ,$62.23 ,$12.76 ,$24.24 ,$100.86 ,$31.90 ,$12.76 ,$104.55 ,$110.70 ,$12.76 ,$92.25 ,$86.10 ,$91.02 ,$91.02 ,$31.90 ,$104.55 ,$12.76 ,$12.76 ,$86.22 ,$12.76 ,$51.17 , N/A ,$104.55 ,$27.43 ,$34.44 ,$110.70 ,$25.52 ,$12.76 ,$79.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101625,84481,HC T3 FREE,301,1 ,$309.00 ,$200.85 ,$16.94 ,$309.00 ,$200.85 ,$16.94 ,$86.52 ,$156.35 ,$16.94 ,$177.68 ,$16.94 ,$156.32 ,$16.94 ,$32.19 ,$253.38 ,$42.35 ,$16.94 ,$262.65 ,$278.10 ,$16.94 ,$231.75 ,$216.30 ,$228.66 ,$228.66 ,$42.35 ,$262.65 ,$16.94 ,$16.94 ,$216.61 ,$16.94 ,$128.54 , N/A ,$262.65 ,$36.42 ,$86.52 ,$278.10 ,$33.88 ,$16.94 ,$200.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101627,84540,HC UREA URINE,301,1 ,$103.00 ,$66.95 ,$5.56 ,$103.00 ,$66.95 ,$5.56 ,$28.84 ,$52.12 ,$5.56 ,$59.23 ,$5.56 ,$52.11 ,$5.56 ,$10.56 ,$84.46 ,$13.90 ,$5.56 ,$87.55 ,$92.70 ,$5.56 ,$77.25 ,$72.10 ,$76.22 ,$76.22 ,$13.90 ,$87.55 ,$5.56 ,$5.56 ,$72.20 ,$5.56 ,$42.85 , N/A ,$87.55 ,$11.95 ,$28.84 ,$92.70 ,$11.12 ,$5.56 ,$66.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101628,84560,HC URIC ACID OTH SRC,301,1 ,$72.00 ,$46.80 ,$5.08 ,$72.00 ,$46.80 ,$5.08 ,$20.16 ,$36.43 ,$5.08 ,$41.40 ,$5.08 ,$36.42 ,$5.08 ,$9.65 ,$59.04 ,$12.70 ,$5.08 ,$61.20 ,$64.80 ,$5.08 ,$54.00 ,$50.40 ,$53.28 ,$53.28 ,$12.70 ,$61.20 ,$5.08 ,$5.08 ,$50.47 ,$5.08 ,$29.95 , N/A ,$61.20 ,$10.92 ,$20.16 ,$64.80 ,$10.16 ,$5.08 ,$46.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101630,84702,HC HCG QN,301,1 ,$168.00 ,$109.20 ,$15.05 ,$168.00 ,$109.20 ,$15.05 ,$47.04 ,$85.01 ,$15.05 ,$96.60 ,$15.05 ,$84.99 ,$15.05 ,$28.60 ,$137.76 ,$37.63 ,$15.05 ,$142.80 ,$151.20 ,$15.05 ,$126.00 ,$117.60 ,$124.32 ,$124.32 ,$37.63 ,$142.80 ,$15.05 ,$15.05 ,$117.77 ,$15.05 ,$69.89 , N/A ,$142.80 ,$32.36 ,$47.04 ,$151.20 ,$30.10 ,$15.05 ,$109.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101633,83070,HC HEMOSIDERIN QL - 90,301,1 ,$46.00 ,$29.90 ,$4.75 ,$46.00 ,$29.90 ,$4.75 ,$12.88 ,$23.28 ,$4.75 ,$26.45 ,$4.75 ,$23.27 ,$4.75 ,$9.03 ,$37.72 ,$11.88 ,$4.75 ,$39.10 ,$41.40 ,$4.75 ,$34.50 ,$32.20 ,$34.04 ,$34.04 ,$11.88 ,$39.10 ,$4.75 ,$4.75 ,$32.25 ,$4.75 ,$19.14 , N/A ,$39.10 ,$10.21 ,$12.88 ,$41.40 ,$9.50 ,$4.75 ,$29.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101636,83735,HC MAGNESIUM,301,1 ,$88.00 ,$57.20 ,$6.70 ,$88.00 ,$57.20 ,$6.70 ,$24.64 ,$44.53 ,$6.70 ,$50.60 ,$6.70 ,$44.52 ,$6.70 ,$12.73 ,$72.16 ,$16.75 ,$6.70 ,$74.80 ,$79.20 ,$6.70 ,$66.00 ,$61.60 ,$65.12 ,$65.12 ,$16.75 ,$74.80 ,$6.70 ,$6.70 ,$61.69 ,$6.70 ,$36.61 , N/A ,$74.80 ,$14.41 ,$24.64 ,$79.20 ,$13.40 ,$6.70 ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101638,84100,HC PHOSPHORUS,301,1 ,$98.00 ,$63.70 ,$4.74 ,$98.00 ,$63.70 ,$4.74 ,$27.44 ,$49.59 ,$4.74 ,$56.35 ,$4.74 ,$49.58 ,$4.74 ,$9.01 ,$80.36 ,$11.85 ,$4.74 ,$83.30 ,$88.20 ,$4.74 ,$73.50 ,$68.60 ,$72.52 ,$72.52 ,$11.85 ,$83.30 ,$4.74 ,$4.74 ,$68.70 ,$4.74 ,$40.77 , N/A ,$83.30 ,$10.19 ,$27.44 ,$88.20 ,$9.48 ,$4.74 ,$63.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101643,81596,HC CHRONIC HEP C VIRUS ASSAYS-90,301,1 ,$612.00 ,$397.80 ,$72.19 ,$612.00 ,$397.80 ,$72.19 ,$171.36 ,$309.67 ,$72.19 ,$351.90 ,$72.19 ,$309.61 ,$72.19 ,$137.16 ,$501.84 ,$180.48 ,$72.19 ,$520.20 ,$550.80 ,$72.19 ,$459.00 ,$428.40 ,$452.88 ,$452.88 ,$180.48 ,$520.20 ,$72.19 ,$72.19 ,$429.01 ,$72.19 ,$254.59 , N/A ,$520.20 ,$155.21 ,$171.36 ,$550.80 ,$144.38 ,$72.19 ,$397.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101653,82642,HC DIHYDROTESTOSTERONE-90,301,1 ,$338.00 ,$219.70 ,$29.28 ,$338.00 ,$219.70 ,$29.28 ,$94.64 ,$171.03 ,$29.28 ,$194.35 ,$29.28 ,$170.99 ,$29.28 ,$55.63 ,$277.16 ,$73.20 ,$29.28 ,$287.30 ,$304.20 ,$29.28 ,$253.50 ,$236.60 ,$250.12 ,$250.12 ,$73.20 ,$287.30 ,$29.28 ,$29.28 ,$236.94 ,$29.28 ,$140.61 , N/A ,$287.30 ,$62.95 ,$94.64 ,$304.20 ,$58.56 ,$29.28 ,$219.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101656,83036,HC HEALTH FAIR HEMOGLOBIN A1C,301,1 ,$10.00 ,$6.50 ,$2.80 ,$24.28 ,$6.50 ,$9.71 ,$2.80 ,$5.06 ,$9.71 ,$5.75 ,$9.71 ,$5.06 ,$9.71 ,$10.00 ,$8.20 ,$24.28 ,$9.71 ,$8.50 ,$9.00 ,$9.71 ,$7.50 ,$7.00 ,$7.40 ,$7.40 ,$10.00 ,$8.50 ,$9.71 ,$9.71 ,$7.01 ,$9.71 ,$4.16 , N/A ,$8.50 ,$20.88 ,$2.80 ,$9.00 ,$10.00 ,$9.71 ,$6.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101657,N/A,HC HEALTH FAIR TOTAL PSA SCREEN,301,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 ,$9.75 , N/A ,$4.20 ,$7.59 , N/A ,$8.63 , N/A ,$7.59 , N/A , N/A ,$12.30 , N/A , N/A ,$12.75 ,$13.50 , N/A ,$11.25 ,$10.50 ,$11.10 ,$11.10 , N/A ,$12.75 , N/A , N/A ,$10.52 , N/A ,$6.24 , N/A ,$12.75 , N/A ,$4.20 ,$13.50 ,$7.50 , N/A ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101658,N/A,HC HEALTH FAIR VITAMIN D 25-OH,301,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 ,$9.75 , N/A ,$4.20 ,$7.59 , N/A ,$8.63 , N/A ,$7.59 , N/A , N/A ,$12.30 , N/A , N/A ,$12.75 ,$13.50 , N/A ,$11.25 ,$10.50 ,$11.10 ,$11.10 , N/A ,$12.75 , N/A , N/A ,$10.52 , N/A ,$6.24 , N/A ,$12.75 , N/A ,$4.20 ,$13.50 ,$7.50 , N/A ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101659,84443,HC HEALTH FAIR TSH,301,1 ,$15.00 ,$9.75 ,$4.20 ,$37.50 ,$9.75 ,$15.00 ,$4.20 ,$7.59 ,$15.00 ,$8.63 ,$15.00 ,$7.59 ,$15.00 ,$15.00 ,$12.30 ,$37.50 ,$15.00 ,$12.75 ,$13.50 ,$15.00 ,$11.25 ,$10.50 ,$11.10 ,$11.10 ,$15.00 ,$12.75 ,$15.00 ,$15.00 ,$10.52 ,$15.00 ,$6.24 , N/A ,$12.75 ,$32.25 ,$4.20 ,$13.50 ,$15.00 ,$15.00 ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101660,N/A,HC HEALTH FAIR LAB PANEL,301,1 ,$45.00 ,$29.25 ,$12.60 ,$45.00 ,$29.25 , N/A ,$12.60 ,$22.77 , N/A ,$25.88 , N/A ,$22.77 , N/A , N/A ,$36.90 , N/A , N/A ,$38.25 ,$40.50 , N/A ,$33.75 ,$31.50 ,$33.30 ,$33.30 , N/A ,$38.25 , N/A , N/A ,$31.55 , N/A ,$18.72 , N/A ,$38.25 , N/A ,$12.60 ,$40.50 ,$22.50 , N/A ,$29.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101661,80061,HC HEALTH FAIR LIPID W/CALC LDL,301,1 ,$15.00 ,$9.75 ,$4.20 ,$33.48 ,$9.75 ,$13.39 ,$4.20 ,$7.59 ,$13.39 ,$8.63 ,$13.39 ,$7.59 ,$13.39 ,$15.00 ,$12.30 ,$33.48 ,$13.39 ,$12.75 ,$13.50 ,$13.39 ,$11.25 ,$10.50 ,$11.10 ,$11.10 ,$15.00 ,$12.75 ,$13.39 ,$13.39 ,$10.52 ,$13.39 ,$6.24 , N/A ,$12.75 ,$28.79 ,$4.20 ,$13.50 ,$15.00 ,$13.39 ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101665,80307,HC DRUG SCREEN MECONIUM-90,301,1 ,$411.00 ,$267.15 ,$62.14 ,$411.00 ,$267.15 ,$62.14 ,$115.08 ,$207.97 ,$62.14 ,$236.33 ,$62.14 ,$207.92 ,$62.14 ,$118.07 ,$337.02 ,$155.35 ,$62.14 ,$349.35 ,$369.90 ,$62.14 ,$308.25 ,$287.70 ,$304.14 ,$304.14 ,$155.35 ,$349.35 ,$62.14 ,$62.14 ,$288.11 ,$62.14 ,$170.98 , N/A ,$349.35 ,$133.60 ,$115.08 ,$369.90 ,$124.28 ,$62.14 ,$267.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101685,80235,HC LACOSAMIDE -90,301,1 ,$147.00 ,$95.55 ,$27.11 ,$147.00 ,$95.55 ,$27.11 ,$41.16 ,$74.38 ,$27.11 ,$84.53 ,$27.11 ,$74.37 ,$27.11 ,$51.51 ,$120.54 ,$67.78 ,$27.11 ,$124.95 ,$132.30 ,$27.11 ,$110.25 ,$102.90 ,$108.78 ,$108.78 ,$67.78 ,$124.95 ,$27.11 ,$27.11 ,$103.05 ,$27.11 ,$61.15 , N/A ,$124.95 ,$58.29 ,$41.16 ,$132.30 ,$54.22 ,$27.11 ,$95.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101689,82565,HC CREATININE,301,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 ,$9.75 ,$5.12 ,$4.20 ,$7.59 ,$5.12 ,$8.63 ,$5.12 ,$7.59 ,$5.12 ,$9.73 ,$12.30 ,$12.80 ,$5.12 ,$12.75 ,$13.50 ,$5.12 ,$11.25 ,$10.50 ,$11.10 ,$11.10 ,$12.80 ,$12.75 ,$5.12 ,$5.12 ,$10.52 ,$5.12 ,$6.24 , N/A ,$12.75 ,$11.01 ,$4.20 ,$13.50 ,$10.24 ,$5.12 ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101755,82553,HC CREATINE MB FRACTION,301,1 ,$35.00 ,$22.75 ,$9.80 ,$35.00 ,$22.75 ,$11.55 ,$9.80 ,$17.71 ,$11.55 ,$20.13 ,$11.55 ,$17.71 ,$11.55 ,$21.95 ,$28.70 ,$28.88 ,$11.55 ,$29.75 ,$31.50 ,$11.55 ,$26.25 ,$24.50 ,$25.90 ,$25.90 ,$28.88 ,$29.75 ,$11.55 ,$11.55 ,$24.54 ,$11.55 ,$14.56 , N/A ,$29.75 ,$24.83 ,$9.80 ,$31.50 ,$23.10 ,$11.55 ,$22.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101756,83721,HC CHOLESTEROL LDL LEVEL,301,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 ,$20.80 ,$10.50 ,$8.96 ,$16.19 ,$10.50 ,$18.40 ,$10.50 ,$16.19 ,$10.50 ,$19.95 ,$26.24 ,$26.25 ,$10.50 ,$27.20 ,$28.80 ,$10.50 ,$24.00 ,$22.40 ,$23.68 ,$23.68 ,$26.25 ,$27.20 ,$10.50 ,$10.50 ,$22.43 ,$10.50 ,$13.31 , N/A ,$27.20 ,$22.58 ,$8.96 ,$28.80 ,$21.00 ,$10.50 ,$20.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101770,83521,HC IMMUNOGLOBULIN LIGHT CHAINS- 90,301,1 ,$169.00 ,$109.85 ,$17.27 ,$169.00 ,$109.85 ,$17.27 ,$47.32 ,$85.51 ,$17.27 ,$97.18 ,$17.27 ,$85.50 ,$17.27 ,$32.81 ,$138.58 ,$43.18 ,$17.27 ,$143.65 ,$152.10 ,$17.27 ,$126.75 ,$118.30 ,$125.06 ,$125.06 ,$43.18 ,$143.65 ,$17.27 ,$17.27 ,$118.47 ,$17.27 ,$70.30 , N/A ,$143.65 ,$37.13 ,$47.32 ,$152.10 ,$34.54 ,$17.27 ,$109.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101771,82653,HC EL-1 FECAL QUANTITATIVE-90,301,1 ,$323.00 ,$209.95 ,$22.97 ,$323.00 ,$209.95 ,$22.97 ,$90.44 ,$163.44 ,$22.97 ,$185.73 ,$22.97 ,$163.41 ,$22.97 ,$43.64 ,$264.86 ,$57.43 ,$22.97 ,$274.55 ,$290.70 ,$22.97 ,$242.25 ,$226.10 ,$239.02 ,$239.02 ,$57.43 ,$274.55 ,$22.97 ,$22.97 ,$226.42 ,$22.97 ,$134.37 , N/A ,$274.55 ,$49.39 ,$90.44 ,$290.70 ,$45.94 ,$22.97 ,$209.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30101774,80053,HC HEALTH FAIR COMPREHENSIVE METABOLIC PANEL,301,1 ,$10.00 ,$6.50 ,$2.80 ,$25.00 ,$6.50 ,$10.00 ,$2.80 ,$5.06 ,$10.00 ,$5.75 ,$10.00 ,$5.06 ,$10.00 ,$10.00 ,$8.20 ,$25.00 ,$10.00 ,$8.50 ,$9.00 ,$10.00 ,$7.50 ,$7.00 ,$7.40 ,$7.40 ,$10.00 ,$8.50 ,$10.00 ,$10.00 ,$7.01 ,$10.00 ,$4.16 , N/A ,$8.50 ,$21.50 ,$2.80 ,$9.00 ,$10.00 ,$10.00 ,$6.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$98.00 ,$63.70 ,$5.18 ,$98.00 ,$63.70 ,$5.18 ,$27.44 ,$49.59 ,$5.18 ,$56.35 ,$5.18 ,$49.58 ,$5.18 ,$9.84 ,$80.36 ,$12.95 ,$5.18 ,$83.30 ,$88.20 ,$5.18 ,$73.50 ,$68.60 ,$72.52 ,$72.52 ,$12.95 ,$83.30 ,$5.18 ,$5.18 ,$68.70 ,$5.18 ,$40.77 , N/A ,$83.30 ,$11.14 ,$27.44 ,$88.20 ,$10.36 ,$5.18 ,$63.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$136.00 ,$88.40 ,$5.18 ,$136.00 ,$88.40 ,$5.18 ,$38.08 ,$68.82 ,$5.18 ,$78.20 ,$5.18 ,$68.80 ,$5.18 ,$9.84 ,$111.52 ,$12.95 ,$5.18 ,$115.60 ,$122.40 ,$5.18 ,$102.00 ,$95.20 ,$100.64 ,$100.64 ,$12.95 ,$115.60 ,$5.18 ,$5.18 ,$95.34 ,$5.18 ,$56.58 , N/A ,$115.60 ,$11.14 ,$38.08 ,$122.40 ,$10.36 ,$5.18 ,$88.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$153.00 ,$99.45 ,$13.71 ,$153.00 ,$99.45 ,$13.71 ,$42.84 ,$77.42 ,$13.71 ,$87.98 ,$13.71 ,$77.40 ,$13.71 ,$26.05 ,$125.46 ,$34.28 ,$13.71 ,$130.05 ,$137.70 ,$13.71 ,$114.75 ,$107.10 ,$113.22 ,$113.22 ,$34.28 ,$130.05 ,$13.71 ,$13.71 ,$107.25 ,$13.71 ,$63.65 , N/A ,$130.05 ,$29.48 ,$42.84 ,$137.70 ,$27.42 ,$13.71 ,$99.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200562,86880,HC COOMBS DIRECT,302,1 ,$104.00 ,$67.60 ,$10.78 ,$137.20 ,$67.60 ,$54.88 ,$29.12 ,$52.62 ,$54.88 ,$59.80 ,$54.88 ,$52.61 ,$54.88 ,$104.00 ,$85.28 ,$137.20 ,$54.88 ,$88.40 ,$93.60 ,$54.88 ,$78.00 ,$72.80 ,$76.96 ,$76.96 ,$104.00 ,$88.40 ,$54.88 ,$54.88 ,$72.90 ,$54.88 ,$43.26 , N/A ,$88.40 ,$117.99 ,$29.12 ,$93.60 ,$10.78 ,$54.88 ,$67.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200563,86885,HC INDIRECT COOMBS,302,1 ,$115.00 ,$74.75 ,$11.44 ,$367.59 ,$74.75 ,$147.04 ,$32.20 ,$58.19 ,$147.04 ,$66.13 ,$115.00 ,$58.18 ,$115.00 ,$115.00 ,$94.30 ,$367.59 ,$147.04 ,$97.75 ,$103.50 ,$147.04 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$115.00 ,$97.75 ,$147.04 ,$147.04 ,$80.62 ,$147.04 ,$47.84 , N/A ,$97.75 ,$316.13 ,$32.20 ,$103.50 ,$11.44 ,$147.04 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200564,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$447.00 ,$290.55 ,$125.16 ,$447.00 ,$290.55 ,$147.04 ,$125.16 ,$226.18 ,$147.04 ,$257.03 ,$147.04 ,$226.14 ,$147.04 ,$279.37 ,$366.54 ,$367.59 ,$147.04 ,$379.95 ,$402.30 ,$147.04 ,$335.25 ,$312.90 ,$330.78 ,$330.78 ,$367.59 ,$379.95 ,$147.04 ,$147.04 ,$313.35 ,$147.04 ,$185.95 , N/A ,$379.95 ,$316.13 ,$125.16 ,$402.30 ,$298.32 ,$147.04 ,$290.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200565,86900,HC BLOOD TYPING ABO,302,1 ,$71.00 ,$46.15 ,$5.98 ,$277.92 ,$46.15 ,$111.17 ,$19.88 ,$35.93 ,$111.17 ,$40.83 ,$71.00 ,$35.92 ,$71.00 ,$71.00 ,$58.22 ,$277.92 ,$111.17 ,$60.35 ,$63.90 ,$111.17 ,$53.25 ,$49.70 ,$52.54 ,$52.54 ,$71.00 ,$60.35 ,$111.17 ,$111.17 ,$49.77 ,$111.17 ,$29.54 , N/A ,$60.35 ,$239.01 ,$19.88 ,$63.90 ,$5.98 ,$111.17 ,$46.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200566,86901,HC BLOOD TYPING RH,302,1 ,$67.00 ,$43.55 ,$5.98 ,$83.43 ,$43.55 ,$33.37 ,$18.76 ,$33.90 ,$33.37 ,$38.53 ,$33.37 ,$33.90 ,$33.37 ,$63.41 ,$54.94 ,$83.43 ,$33.37 ,$56.95 ,$60.30 ,$33.37 ,$50.25 ,$46.90 ,$49.58 ,$49.58 ,$67.00 ,$56.95 ,$33.37 ,$33.37 ,$46.97 ,$33.37 ,$27.87 , N/A ,$56.95 ,$71.75 ,$18.76 ,$60.30 ,$5.98 ,$33.37 ,$43.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200569,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$52.00 ,$33.80 ,$14.56 ,$367.59 ,$33.80 ,$147.04 ,$14.56 ,$26.31 ,$147.04 ,$29.90 ,$52.00 ,$26.31 ,$52.00 ,$52.00 ,$42.64 ,$367.59 ,$147.04 ,$44.20 ,$46.80 ,$147.04 ,$39.00 ,$36.40 ,$38.48 ,$38.48 ,$52.00 ,$44.20 ,$147.04 ,$147.04 ,$36.45 ,$147.04 ,$21.63 , N/A ,$44.20 ,$316.13 ,$14.56 ,$46.80 ,$52.00 ,$147.04 ,$33.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200571,86922,HC CROSSMATCH AHG,302,1 ,$135.00 ,$87.75 ,$37.80 ,$367.59 ,$87.75 ,$147.04 ,$37.80 ,$68.31 ,$147.04 ,$77.63 ,$135.00 ,$68.30 ,$135.00 ,$135.00 ,$110.70 ,$367.59 ,$147.04 ,$114.75 ,$121.50 ,$147.04 ,$101.25 ,$94.50 ,$99.90 ,$99.90 ,$135.00 ,$114.75 ,$147.04 ,$147.04 ,$94.64 ,$147.04 ,$56.16 , N/A ,$114.75 ,$316.13 ,$37.80 ,$121.50 ,$135.00 ,$147.04 ,$87.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200845,86003,HC RAST ALLERGEN IGE QN SQ EA-90,302,1 ,$63.00 ,$40.95 ,$5.22 ,$63.00 ,$40.95 ,$5.22 ,$17.64 ,$31.88 ,$5.22 ,$36.23 ,$5.22 ,$31.87 ,$5.22 ,$9.92 ,$51.66 ,$13.05 ,$5.22 ,$53.55 ,$56.70 ,$5.22 ,$47.25 ,$44.10 ,$46.62 ,$46.62 ,$13.05 ,$53.55 ,$5.22 ,$5.22 ,$44.16 ,$5.22 ,$26.21 , N/A ,$53.55 ,$11.22 ,$17.64 ,$56.70 ,$10.44 ,$5.22 ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200847,86021,HC LEUKO AB ID-90,302,1 ,$278.00 ,$180.70 ,$15.05 ,$278.00 ,$180.70 ,$15.05 ,$77.84 ,$140.67 ,$15.05 ,$159.85 ,$15.05 ,$140.64 ,$15.05 ,$28.60 ,$227.96 ,$37.63 ,$15.05 ,$236.30 ,$250.20 ,$15.05 ,$208.50 ,$194.60 ,$205.72 ,$205.72 ,$37.63 ,$236.30 ,$15.05 ,$15.05 ,$194.88 ,$15.05 ,$115.65 , N/A ,$236.30 ,$32.36 ,$77.84 ,$250.20 ,$30.10 ,$15.05 ,$180.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200851,86022,HC PLATELET AB ID-90,302,1 ,$174.00 ,$113.10 ,$18.37 ,$174.00 ,$113.10 ,$18.37 ,$48.72 ,$88.04 ,$18.37 ,$100.05 ,$18.37 ,$88.03 ,$18.37 ,$34.90 ,$142.68 ,$45.93 ,$18.37 ,$147.90 ,$156.60 ,$18.37 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$45.93 ,$147.90 ,$18.37 ,$18.37 ,$121.97 ,$18.37 ,$72.38 , N/A ,$147.90 ,$39.50 ,$48.72 ,$156.60 ,$36.74 ,$18.37 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200857,86023,HC PLATELET ASSOC AB ID IGG-90,302,1 ,$126.00 ,$81.90 ,$12.46 ,$126.00 ,$81.90 ,$12.46 ,$35.28 ,$63.76 ,$12.46 ,$72.45 ,$12.46 ,$63.74 ,$12.46 ,$23.67 ,$103.32 ,$31.15 ,$12.46 ,$107.10 ,$113.40 ,$12.46 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$31.15 ,$107.10 ,$12.46 ,$12.46 ,$88.33 ,$12.46 ,$52.42 , N/A ,$107.10 ,$26.79 ,$35.28 ,$113.40 ,$24.92 ,$12.46 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200858,86038,HC ANA SCREEN-90,302,1 ,$168.00 ,$109.20 ,$12.09 ,$168.00 ,$109.20 ,$12.09 ,$47.04 ,$85.01 ,$12.09 ,$96.60 ,$12.09 ,$84.99 ,$12.09 ,$22.97 ,$137.76 ,$30.23 ,$12.09 ,$142.80 ,$151.20 ,$12.09 ,$126.00 ,$117.60 ,$124.32 ,$124.32 ,$30.23 ,$142.80 ,$12.09 ,$12.09 ,$117.77 ,$12.09 ,$69.89 , N/A ,$142.80 ,$25.99 ,$47.04 ,$151.20 ,$24.18 ,$12.09 ,$109.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200859,86039,HC ANA TITER-90,302,1 ,$117.00 ,$76.05 ,$11.16 ,$117.00 ,$76.05 ,$11.16 ,$32.76 ,$59.20 ,$11.16 ,$67.28 ,$11.16 ,$59.19 ,$11.16 ,$21.20 ,$95.94 ,$27.90 ,$11.16 ,$99.45 ,$105.30 ,$11.16 ,$87.75 ,$81.90 ,$86.58 ,$86.58 ,$27.90 ,$99.45 ,$11.16 ,$11.16 ,$82.02 ,$11.16 ,$48.67 , N/A ,$99.45 ,$23.99 ,$32.76 ,$105.30 ,$22.32 ,$11.16 ,$76.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200860,86060,HC ASO-90,302,1 ,$107.00 ,$69.55 ,$7.30 ,$107.00 ,$69.55 ,$7.30 ,$29.96 ,$54.14 ,$7.30 ,$61.53 ,$7.30 ,$54.13 ,$7.30 ,$13.87 ,$87.74 ,$18.25 ,$7.30 ,$90.95 ,$96.30 ,$7.30 ,$80.25 ,$74.90 ,$79.18 ,$79.18 ,$18.25 ,$90.95 ,$7.30 ,$7.30 ,$75.01 ,$7.30 ,$44.51 , N/A ,$90.95 ,$15.70 ,$29.96 ,$96.30 ,$14.60 ,$7.30 ,$69.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200864,86146,HC BETA 2 GLYCO AB-90,302,1 ,$94.00 ,$61.10 ,$25.45 ,$94.00 ,$61.10 ,$25.45 ,$26.32 ,$47.56 ,$25.45 ,$54.05 ,$25.45 ,$47.55 ,$25.45 ,$48.36 ,$77.08 ,$63.63 ,$25.45 ,$79.90 ,$84.60 ,$25.45 ,$70.50 ,$65.80 ,$69.56 ,$69.56 ,$63.63 ,$79.90 ,$25.45 ,$25.45 ,$65.89 ,$25.45 ,$39.10 , N/A ,$79.90 ,$54.72 ,$26.32 ,$84.60 ,$50.90 ,$25.45 ,$61.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200865,86147,HC CARDIOLIPIN AB EA-90,302,1 ,$156.00 ,$101.40 ,$25.45 ,$156.00 ,$101.40 ,$25.45 ,$43.68 ,$78.94 ,$25.45 ,$89.70 ,$25.45 ,$78.92 ,$25.45 ,$48.36 ,$127.92 ,$63.63 ,$25.45 ,$132.60 ,$140.40 ,$25.45 ,$117.00 ,$109.20 ,$115.44 ,$115.44 ,$63.63 ,$132.60 ,$25.45 ,$25.45 ,$109.36 ,$25.45 ,$64.90 , N/A ,$132.60 ,$54.72 ,$43.68 ,$140.40 ,$50.90 ,$25.45 ,$101.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200866,86148,HC ANTI-PHOSPHATIDYLSERINE AB-90,302,1 ,$60.00 ,$39.00 ,$16.07 ,$60.00 ,$39.00 ,$16.07 ,$16.80 ,$30.36 ,$16.07 ,$34.50 ,$16.07 ,$30.35 ,$16.07 ,$30.53 ,$49.20 ,$40.18 ,$16.07 ,$51.00 ,$54.00 ,$16.07 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$40.18 ,$51.00 ,$16.07 ,$16.07 ,$42.06 ,$16.07 ,$24.96 , N/A ,$51.00 ,$34.55 ,$16.80 ,$54.00 ,$32.14 ,$16.07 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200868,86157,HC COLD AGGLUTININ TITER-90,302,1 ,$221.00 ,$143.65 ,$8.06 ,$221.00 ,$143.65 ,$8.06 ,$61.88 ,$111.83 ,$8.06 ,$127.08 ,$8.06 ,$111.80 ,$8.06 ,$15.31 ,$181.22 ,$20.15 ,$8.06 ,$187.85 ,$198.90 ,$8.06 ,$165.75 ,$154.70 ,$163.54 ,$163.54 ,$20.15 ,$187.85 ,$8.06 ,$8.06 ,$154.92 ,$8.06 ,$91.94 , N/A ,$187.85 ,$17.33 ,$61.88 ,$198.90 ,$16.12 ,$8.06 ,$143.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200869,86160,HC COMPLEMENT AG EA-90,302,1 ,$162.00 ,$105.30 ,$12.00 ,$162.00 ,$105.30 ,$12.00 ,$45.36 ,$81.97 ,$12.00 ,$93.15 ,$12.00 ,$81.96 ,$12.00 ,$22.80 ,$132.84 ,$30.00 ,$12.00 ,$137.70 ,$145.80 ,$12.00 ,$121.50 ,$113.40 ,$119.88 ,$119.88 ,$30.00 ,$137.70 ,$12.00 ,$12.00 ,$113.56 ,$12.00 ,$67.39 , N/A ,$137.70 ,$25.80 ,$45.36 ,$145.80 ,$24.00 ,$12.00 ,$105.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200870,86161,HC C1 ESTERASE INHIBITOR-90,302,1 ,$276.00 ,$179.40 ,$12.00 ,$276.00 ,$179.40 ,$12.00 ,$77.28 ,$139.66 ,$12.00 ,$158.70 ,$12.00 ,$139.63 ,$12.00 ,$22.80 ,$226.32 ,$30.00 ,$12.00 ,$234.60 ,$248.40 ,$12.00 ,$207.00 ,$193.20 ,$204.24 ,$204.24 ,$30.00 ,$234.60 ,$12.00 ,$12.00 ,$193.48 ,$12.00 ,$114.82 , N/A ,$234.60 ,$25.80 ,$77.28 ,$248.40 ,$24.00 ,$12.00 ,$179.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200871,86162,HC COMPLEMENT TOTAL-90,302,1 ,$277.00 ,$180.05 ,$20.32 ,$277.00 ,$180.05 ,$20.32 ,$77.56 ,$140.16 ,$20.32 ,$159.28 ,$20.32 ,$140.13 ,$20.32 ,$38.61 ,$227.14 ,$50.80 ,$20.32 ,$235.45 ,$249.30 ,$20.32 ,$207.75 ,$193.90 ,$204.98 ,$204.98 ,$50.80 ,$235.45 ,$20.32 ,$20.32 ,$194.18 ,$20.32 ,$115.23 , N/A ,$235.45 ,$43.69 ,$77.56 ,$249.30 ,$40.64 ,$20.32 ,$180.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200873,86200,HC CCP AB-90,302,1 ,$85.00 ,$55.25 ,$12.95 ,$85.00 ,$55.25 ,$12.95 ,$23.80 ,$43.01 ,$12.95 ,$48.88 ,$12.95 ,$43.00 ,$12.95 ,$24.61 ,$69.70 ,$32.38 ,$12.95 ,$72.25 ,$76.50 ,$12.95 ,$63.75 ,$59.50 ,$62.90 ,$62.90 ,$32.38 ,$72.25 ,$12.95 ,$12.95 ,$59.59 ,$12.95 ,$35.36 , N/A ,$72.25 ,$27.84 ,$23.80 ,$76.50 ,$25.90 ,$12.95 ,$55.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200874,86215,HC DEOXYRIBONUCLEASE AB-90,302,1 ,$139.00 ,$90.35 ,$13.25 ,$139.00 ,$90.35 ,$13.25 ,$38.92 ,$70.33 ,$13.25 ,$79.93 ,$13.25 ,$70.32 ,$13.25 ,$25.18 ,$113.98 ,$33.13 ,$13.25 ,$118.15 ,$125.10 ,$13.25 ,$104.25 ,$97.30 ,$102.86 ,$102.86 ,$33.13 ,$118.15 ,$13.25 ,$13.25 ,$97.44 ,$13.25 ,$57.82 , N/A ,$118.15 ,$28.49 ,$38.92 ,$125.10 ,$26.50 ,$13.25 ,$90.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200875,86225,HC DNA DOUBLE STRAND AB-90,302,1 ,$237.00 ,$154.05 ,$13.74 ,$237.00 ,$154.05 ,$13.74 ,$66.36 ,$119.92 ,$13.74 ,$136.28 ,$13.74 ,$119.90 ,$13.74 ,$26.11 ,$194.34 ,$34.35 ,$13.74 ,$201.45 ,$213.30 ,$13.74 ,$177.75 ,$165.90 ,$175.38 ,$175.38 ,$34.35 ,$201.45 ,$13.74 ,$13.74 ,$166.14 ,$13.74 ,$98.59 , N/A ,$201.45 ,$29.54 ,$66.36 ,$213.30 ,$27.48 ,$13.74 ,$154.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200877,86235,HC ENA AB-90,302,1 ,$189.00 ,$122.85 ,$17.93 ,$189.00 ,$122.85 ,$17.93 ,$52.92 ,$95.63 ,$17.93 ,$108.68 ,$17.93 ,$95.62 ,$17.93 ,$34.07 ,$154.98 ,$44.83 ,$17.93 ,$160.65 ,$170.10 ,$17.93 ,$141.75 ,$132.30 ,$139.86 ,$139.86 ,$44.83 ,$160.65 ,$17.93 ,$17.93 ,$132.49 ,$17.93 ,$78.62 , N/A ,$160.65 ,$38.55 ,$52.92 ,$170.10 ,$35.86 ,$17.93 ,$122.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200878,86255,HC FLUOR AB SCR-90,302,1 ,$184.00 ,$119.60 ,$12.05 ,$184.00 ,$119.60 ,$12.05 ,$51.52 ,$93.10 ,$12.05 ,$105.80 ,$12.05 ,$93.09 ,$12.05 ,$22.90 ,$150.88 ,$30.13 ,$12.05 ,$156.40 ,$165.60 ,$12.05 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$30.13 ,$156.40 ,$12.05 ,$12.05 ,$128.98 ,$12.05 ,$76.54 , N/A ,$156.40 ,$25.91 ,$51.52 ,$165.60 ,$24.10 ,$12.05 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200879,86256,HC FLUOR AB TITER-90,302,1 ,$56.00 ,$36.40 ,$12.05 ,$56.00 ,$36.40 ,$12.05 ,$15.68 ,$28.34 ,$12.05 ,$32.20 ,$12.05 ,$28.33 ,$12.05 ,$22.90 ,$45.92 ,$30.13 ,$12.05 ,$47.60 ,$50.40 ,$12.05 ,$42.00 ,$39.20 ,$41.44 ,$41.44 ,$30.13 ,$47.60 ,$12.05 ,$12.05 ,$39.26 ,$12.05 ,$23.30 , N/A ,$47.60 ,$25.91 ,$15.68 ,$50.40 ,$24.10 ,$12.05 ,$36.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200880,86300,HC TUMOR AG CA 15-3 (27.29)-90,302,1 ,$179.00 ,$116.35 ,$20.81 ,$179.00 ,$116.35 ,$20.81 ,$50.12 ,$90.57 ,$20.81 ,$102.93 ,$20.81 ,$90.56 ,$20.81 ,$39.54 ,$146.78 ,$52.03 ,$20.81 ,$152.15 ,$161.10 ,$20.81 ,$134.25 ,$125.30 ,$132.46 ,$132.46 ,$52.03 ,$152.15 ,$20.81 ,$20.81 ,$125.48 ,$20.81 ,$74.46 , N/A ,$152.15 ,$44.74 ,$50.12 ,$161.10 ,$41.62 ,$20.81 ,$116.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200881,86301,HC TUMOR AG CA 19-9  -90,302,1 ,$187.00 ,$121.55 ,$20.81 ,$187.00 ,$121.55 ,$20.81 ,$52.36 ,$94.62 ,$20.81 ,$107.53 ,$20.81 ,$94.60 ,$20.81 ,$39.54 ,$153.34 ,$52.03 ,$20.81 ,$158.95 ,$168.30 ,$20.81 ,$140.25 ,$130.90 ,$138.38 ,$138.38 ,$52.03 ,$158.95 ,$20.81 ,$20.81 ,$131.09 ,$20.81 ,$77.79 , N/A ,$158.95 ,$44.74 ,$52.36 ,$168.30 ,$41.62 ,$20.81 ,$121.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200882,86304,HC TUMOR AG CA 125 -90,302,1 ,$219.00 ,$142.35 ,$20.81 ,$219.00 ,$142.35 ,$20.81 ,$61.32 ,$110.81 ,$20.81 ,$125.93 ,$20.81 ,$110.79 ,$20.81 ,$39.54 ,$179.58 ,$52.03 ,$20.81 ,$186.15 ,$197.10 ,$20.81 ,$164.25 ,$153.30 ,$162.06 ,$162.06 ,$52.03 ,$186.15 ,$20.81 ,$20.81 ,$153.52 ,$20.81 ,$91.10 , N/A ,$186.15 ,$44.74 ,$61.32 ,$197.10 ,$41.62 ,$20.81 ,$142.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200883,86305,HC HE4 OVARIAN CANCER-90,302,1 ,"$1,081.00 ",$702.65 ,$20.81 ,"$1,081.00 ",$702.65 ,$20.81 ,$302.68 ,$546.99 ,$20.81 ,$621.58 ,$20.81 ,$546.88 ,$20.81 ,$39.54 ,$886.42 ,$52.03 ,$20.81 ,$918.85 ,$972.90 ,$20.81 ,$810.75 ,$756.70 ,$799.94 ,$799.94 ,$52.03 ,$918.85 ,$20.81 ,$20.81 ,$757.78 ,$20.81 ,$449.70 , N/A ,$918.85 ,$44.74 ,$302.68 ,$972.90 ,$41.62 ,$20.81 ,$702.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200886,86632,HC CHLAMYDIA AB IGM-90,302,1 ,$161.00 ,$104.65 ,$12.68 ,$161.00 ,$104.65 ,$12.68 ,$45.08 ,$81.47 ,$12.68 ,$92.58 ,$12.68 ,$81.45 ,$12.68 ,$24.09 ,$132.02 ,$31.70 ,$12.68 ,$136.85 ,$144.90 ,$12.68 ,$120.75 ,$112.70 ,$119.14 ,$119.14 ,$31.70 ,$136.85 ,$12.68 ,$12.68 ,$112.86 ,$12.68 ,$66.98 , N/A ,$136.85 ,$27.26 ,$45.08 ,$144.90 ,$25.36 ,$12.68 ,$104.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200887,86635,HC COCCIDIOIDES AB-90,302,1 ,$148.00 ,$96.20 ,$11.47 ,$148.00 ,$96.20 ,$11.47 ,$41.44 ,$74.89 ,$11.47 ,$85.10 ,$11.47 ,$74.87 ,$11.47 ,$21.79 ,$121.36 ,$28.68 ,$11.47 ,$125.80 ,$133.20 ,$11.47 ,$111.00 ,$103.60 ,$109.52 ,$109.52 ,$28.68 ,$125.80 ,$11.47 ,$11.47 ,$103.75 ,$11.47 ,$61.57 , N/A ,$125.80 ,$24.66 ,$41.44 ,$133.20 ,$22.94 ,$11.47 ,$96.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200889,86641,HC CRYPTOCOCCAL AB-90,302,1 ,$20.44 ,$13.29 ,$5.72 ,$36.03 ,$13.29 ,$14.41 ,$5.72 ,$10.34 ,$14.41 ,$11.75 ,$14.41 ,$10.34 ,$14.41 ,$20.44 ,$16.76 ,$36.03 ,$14.41 ,$17.37 ,$18.40 ,$14.41 ,$15.33 ,$14.31 ,$15.13 ,$15.13 ,$20.44 ,$17.37 ,$14.41 ,$14.41 ,$14.33 ,$14.41 ,$8.50 , N/A ,$17.37 ,$30.98 ,$5.72 ,$18.40 ,$20.44 ,$14.41 ,$13.29 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200890,86644,HC CMV AB-90,302,1 ,$63.00 ,$40.95 ,$14.39 ,$63.00 ,$40.95 ,$14.39 ,$17.64 ,$31.88 ,$14.39 ,$36.23 ,$14.39 ,$31.87 ,$14.39 ,$27.34 ,$51.66 ,$35.98 ,$14.39 ,$53.55 ,$56.70 ,$14.39 ,$47.25 ,$44.10 ,$46.62 ,$46.62 ,$35.98 ,$53.55 ,$14.39 ,$14.39 ,$44.16 ,$14.39 ,$26.21 , N/A ,$53.55 ,$30.94 ,$17.64 ,$56.70 ,$28.78 ,$14.39 ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200891,86645,HC CMV AB IGM-90,302,1 ,$196.00 ,$127.40 ,$16.85 ,$196.00 ,$127.40 ,$16.85 ,$54.88 ,$99.18 ,$16.85 ,$112.70 ,$16.85 ,$99.16 ,$16.85 ,$32.02 ,$160.72 ,$42.13 ,$16.85 ,$166.60 ,$176.40 ,$16.85 ,$147.00 ,$137.20 ,$145.04 ,$145.04 ,$42.13 ,$166.60 ,$16.85 ,$16.85 ,$137.40 ,$16.85 ,$81.54 , N/A ,$166.60 ,$36.23 ,$54.88 ,$176.40 ,$33.70 ,$16.85 ,$127.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200892,86648,HC DIPTHERIA-90,302,1 ,$183.00 ,$118.95 ,$15.21 ,$183.00 ,$118.95 ,$15.21 ,$51.24 ,$92.60 ,$15.21 ,$105.23 ,$15.21 ,$92.58 ,$15.21 ,$28.90 ,$150.06 ,$38.03 ,$15.21 ,$155.55 ,$164.70 ,$15.21 ,$137.25 ,$128.10 ,$135.42 ,$135.42 ,$38.03 ,$155.55 ,$15.21 ,$15.21 ,$128.28 ,$15.21 ,$76.13 , N/A ,$155.55 ,$32.70 ,$51.24 ,$164.70 ,$30.42 ,$15.21 ,$118.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200897,86658,HC ENTEROVIRUS AB-90,302,1 ,$31.00 ,$20.15 ,$8.68 ,$32.58 ,$20.15 ,$13.03 ,$8.68 ,$15.69 ,$13.03 ,$17.83 ,$13.03 ,$15.68 ,$13.03 ,$24.76 ,$25.42 ,$32.58 ,$13.03 ,$26.35 ,$27.90 ,$13.03 ,$23.25 ,$21.70 ,$22.94 ,$22.94 ,$31.00 ,$26.35 ,$13.03 ,$13.03 ,$21.73 ,$13.03 ,$12.90 , N/A ,$26.35 ,$28.01 ,$8.68 ,$27.90 ,$26.06 ,$13.03 ,$20.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200898,86663,HC EBV EARLY AG-90,302,1 ,$194.00 ,$126.10 ,$13.12 ,$194.00 ,$126.10 ,$13.12 ,$54.32 ,$98.16 ,$13.12 ,$111.55 ,$13.12 ,$98.14 ,$13.12 ,$24.93 ,$159.08 ,$32.80 ,$13.12 ,$164.90 ,$174.60 ,$13.12 ,$145.50 ,$135.80 ,$143.56 ,$143.56 ,$32.80 ,$164.90 ,$13.12 ,$13.12 ,$135.99 ,$13.12 ,$80.70 , N/A ,$164.90 ,$28.21 ,$54.32 ,$174.60 ,$26.24 ,$13.12 ,$126.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200899,86664,HC EBV NUCLEAR AG-90,302,1 ,$64.00 ,$41.60 ,$15.29 ,$64.00 ,$41.60 ,$15.29 ,$17.92 ,$32.38 ,$15.29 ,$36.80 ,$15.29 ,$32.38 ,$15.29 ,$29.05 ,$52.48 ,$38.23 ,$15.29 ,$54.40 ,$57.60 ,$15.29 ,$48.00 ,$44.80 ,$47.36 ,$47.36 ,$38.23 ,$54.40 ,$15.29 ,$15.29 ,$44.86 ,$15.29 ,$26.62 , N/A ,$54.40 ,$32.87 ,$17.92 ,$57.60 ,$30.58 ,$15.29 ,$41.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200900,86665,HC EBV VIRAL CAP-90,302,1 ,$118.00 ,$76.70 ,$18.14 ,$118.00 ,$76.70 ,$18.14 ,$33.04 ,$59.71 ,$18.14 ,$67.85 ,$18.14 ,$59.70 ,$18.14 ,$34.47 ,$96.76 ,$45.35 ,$18.14 ,$100.30 ,$106.20 ,$18.14 ,$88.50 ,$82.60 ,$87.32 ,$87.32 ,$45.35 ,$100.30 ,$18.14 ,$18.14 ,$82.72 ,$18.14 ,$49.09 , N/A ,$100.30 ,$39.00 ,$33.04 ,$106.20 ,$36.28 ,$18.14 ,$76.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200901,86666,HC EHRLICHIA AB-90,302,1 ,$151.00 ,$98.15 ,$10.18 ,$151.00 ,$98.15 ,$10.18 ,$42.28 ,$76.41 ,$10.18 ,$86.83 ,$10.18 ,$76.39 ,$10.18 ,$19.34 ,$123.82 ,$25.45 ,$10.18 ,$128.35 ,$135.90 ,$10.18 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$25.45 ,$128.35 ,$10.18 ,$10.18 ,$105.85 ,$10.18 ,$62.82 , N/A ,$128.35 ,$21.89 ,$42.28 ,$135.90 ,$20.36 ,$10.18 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200902,86668,HC FRANCISELLA AB-90,302,1 ,$184.00 ,$119.60 ,$14.16 ,$184.00 ,$119.60 ,$14.16 ,$51.52 ,$93.10 ,$14.16 ,$105.80 ,$14.16 ,$93.09 ,$14.16 ,$26.90 ,$150.88 ,$35.40 ,$14.16 ,$156.40 ,$165.60 ,$14.16 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$35.40 ,$156.40 ,$14.16 ,$14.16 ,$128.98 ,$14.16 ,$76.54 , N/A ,$156.40 ,$30.44 ,$51.52 ,$165.60 ,$28.32 ,$14.16 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200903,86671,HC FUNGUS AB NOS-90,302,1 ,$156.00 ,$101.40 ,$12.25 ,$156.00 ,$101.40 ,$12.25 ,$43.68 ,$78.94 ,$12.25 ,$89.70 ,$12.25 ,$78.92 ,$12.25 ,$23.28 ,$127.92 ,$30.63 ,$12.25 ,$132.60 ,$140.40 ,$12.25 ,$117.00 ,$109.20 ,$115.44 ,$115.44 ,$30.63 ,$132.60 ,$12.25 ,$12.25 ,$109.36 ,$12.25 ,$64.90 , N/A ,$132.60 ,$26.34 ,$43.68 ,$140.40 ,$24.50 ,$12.25 ,$101.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200907,86684,HC HAEMOPHILUS INFLUENZA AB-90,302,1 ,$454.00 ,$295.10 ,$15.84 ,$454.00 ,$295.10 ,$15.84 ,$127.12 ,$229.72 ,$15.84 ,$261.05 ,$15.84 ,$229.68 ,$15.84 ,$30.10 ,$372.28 ,$39.60 ,$15.84 ,$385.90 ,$408.60 ,$15.84 ,$340.50 ,$317.80 ,$335.96 ,$335.96 ,$39.60 ,$385.90 ,$15.84 ,$15.84 ,$318.25 ,$15.84 ,$188.86 , N/A ,$385.90 ,$34.06 ,$127.12 ,$408.60 ,$31.68 ,$15.84 ,$295.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200909,86689,HC HTLV OR HIV AB CONF-90,302,1 ,$124.00 ,$80.60 ,$19.35 ,$124.00 ,$80.60 ,$19.35 ,$34.72 ,$62.74 ,$19.35 ,$71.30 ,$19.35 ,$62.73 ,$19.35 ,$36.77 ,$101.68 ,$48.38 ,$19.35 ,$105.40 ,$111.60 ,$19.35 ,$93.00 ,$86.80 ,$91.76 ,$91.76 ,$48.38 ,$105.40 ,$19.35 ,$19.35 ,$86.92 ,$19.35 ,$51.58 , N/A ,$105.40 ,$41.60 ,$34.72 ,$111.60 ,$38.70 ,$19.35 ,$80.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200912,86695,HC HERPES SIMPLEX AB I-90,302,1 ,$182.00 ,$118.30 ,$13.19 ,$182.00 ,$118.30 ,$13.19 ,$50.96 ,$92.09 ,$13.19 ,$104.65 ,$13.19 ,$92.07 ,$13.19 ,$25.06 ,$149.24 ,$32.98 ,$13.19 ,$154.70 ,$163.80 ,$13.19 ,$136.50 ,$127.40 ,$134.68 ,$134.68 ,$32.98 ,$154.70 ,$13.19 ,$13.19 ,$127.58 ,$13.19 ,$75.71 , N/A ,$154.70 ,$28.36 ,$50.96 ,$163.80 ,$26.38 ,$13.19 ,$118.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200913,86696,HC HERPES SIMPLEX AB II-90,302,1 ,$118.00 ,$76.70 ,$19.35 ,$118.00 ,$76.70 ,$19.35 ,$33.04 ,$59.71 ,$19.35 ,$67.85 ,$19.35 ,$59.70 ,$19.35 ,$36.77 ,$96.76 ,$48.38 ,$19.35 ,$100.30 ,$106.20 ,$19.35 ,$88.50 ,$82.60 ,$87.32 ,$87.32 ,$48.38 ,$100.30 ,$19.35 ,$19.35 ,$82.72 ,$19.35 ,$49.09 , N/A ,$100.30 ,$41.60 ,$33.04 ,$106.20 ,$38.70 ,$19.35 ,$76.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200914,86698,HC HISTOPLASMA AB-90,302,1 ,$152.00 ,$98.80 ,$13.79 ,$152.00 ,$98.80 ,$13.79 ,$42.56 ,$76.91 ,$13.79 ,$87.40 ,$13.79 ,$76.90 ,$13.79 ,$26.20 ,$124.64 ,$34.48 ,$13.79 ,$129.20 ,$136.80 ,$13.79 ,$114.00 ,$106.40 ,$112.48 ,$112.48 ,$34.48 ,$129.20 ,$13.79 ,$13.79 ,$106.55 ,$13.79 ,$63.23 , N/A ,$129.20 ,$29.65 ,$42.56 ,$136.80 ,$27.58 ,$13.79 ,$98.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200915,86701,HC HIV-1 AB-90,302,1 ,$50.00 ,$32.50 ,$8.89 ,$50.00 ,$32.50 ,$8.89 ,$14.00 ,$25.30 ,$8.89 ,$28.75 ,$8.89 ,$25.30 ,$8.89 ,$16.89 ,$41.00 ,$22.23 ,$8.89 ,$42.50 ,$45.00 ,$8.89 ,$37.50 ,$35.00 ,$37.00 ,$37.00 ,$22.23 ,$42.50 ,$8.89 ,$8.89 ,$35.05 ,$8.89 ,$20.80 , N/A ,$42.50 ,$19.11 ,$14.00 ,$45.00 ,$17.78 ,$8.89 ,$32.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200918,86702,HC HIV-2 AB-90,302,1 ,$50.00 ,$32.50 ,$13.52 ,$50.00 ,$32.50 ,$13.52 ,$14.00 ,$25.30 ,$13.52 ,$28.75 ,$13.52 ,$25.30 ,$13.52 ,$25.69 ,$41.00 ,$33.80 ,$13.52 ,$42.50 ,$45.00 ,$13.52 ,$37.50 ,$35.00 ,$37.00 ,$37.00 ,$33.80 ,$42.50 ,$13.52 ,$13.52 ,$35.05 ,$13.52 ,$20.80 , N/A ,$42.50 ,$29.07 ,$14.00 ,$45.00 ,$27.04 ,$13.52 ,$32.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200923,86707,HC HEP B E AB-90,302,1 ,$78.00 ,$50.70 ,$11.57 ,$78.00 ,$50.70 ,$11.57 ,$21.84 ,$39.47 ,$11.57 ,$44.85 ,$11.57 ,$39.46 ,$11.57 ,$21.98 ,$63.96 ,$28.93 ,$11.57 ,$66.30 ,$70.20 ,$11.57 ,$58.50 ,$54.60 ,$57.72 ,$57.72 ,$28.93 ,$66.30 ,$11.57 ,$11.57 ,$54.68 ,$11.57 ,$32.45 , N/A ,$66.30 ,$24.88 ,$21.84 ,$70.20 ,$23.14 ,$11.57 ,$50.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200924,86708,HC HEP A AB TOTAL-90,302,1 ,$24.00 ,$15.60 ,$6.72 ,$30.98 ,$15.60 ,$12.39 ,$6.72 ,$12.14 ,$12.39 ,$13.80 ,$12.39 ,$12.14 ,$12.39 ,$23.54 ,$19.68 ,$30.98 ,$12.39 ,$20.40 ,$21.60 ,$12.39 ,$18.00 ,$16.80 ,$17.76 ,$17.76 ,$24.00 ,$20.40 ,$12.39 ,$12.39 ,$16.82 ,$12.39 ,$9.98 , N/A ,$20.40 ,$26.64 ,$6.72 ,$21.60 ,$24.00 ,$12.39 ,$15.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200926,86710,HC INFLUENZA AB-90,302,1 ,$145.00 ,$94.25 ,$13.55 ,$145.00 ,$94.25 ,$13.55 ,$40.60 ,$73.37 ,$13.55 ,$83.38 ,$13.55 ,$73.36 ,$13.55 ,$25.75 ,$118.90 ,$33.88 ,$13.55 ,$123.25 ,$130.50 ,$13.55 ,$108.75 ,$101.50 ,$107.30 ,$107.30 ,$33.88 ,$123.25 ,$13.55 ,$13.55 ,$101.65 ,$13.55 ,$60.32 , N/A ,$123.25 ,$29.13 ,$40.60 ,$130.50 ,$27.10 ,$13.55 ,$94.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200927,86713,HC LEGIONELLA AB-90,302,1 ,$86.00 ,$55.90 ,$15.30 ,$86.00 ,$55.90 ,$15.30 ,$24.08 ,$43.52 ,$15.30 ,$49.45 ,$15.30 ,$43.51 ,$15.30 ,$29.07 ,$70.52 ,$38.25 ,$15.30 ,$73.10 ,$77.40 ,$15.30 ,$64.50 ,$60.20 ,$63.64 ,$63.64 ,$38.25 ,$73.10 ,$15.30 ,$15.30 ,$60.29 ,$15.30 ,$35.78 , N/A ,$73.10 ,$32.90 ,$24.08 ,$77.40 ,$30.60 ,$15.30 ,$55.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200931,86735,HC MUMPS AB-90,302,1 ,$126.00 ,$81.90 ,$13.05 ,$126.00 ,$81.90 ,$13.05 ,$35.28 ,$63.76 ,$13.05 ,$72.45 ,$13.05 ,$63.74 ,$13.05 ,$24.80 ,$103.32 ,$32.63 ,$13.05 ,$107.10 ,$113.40 ,$13.05 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$32.63 ,$107.10 ,$13.05 ,$13.05 ,$88.33 ,$13.05 ,$52.42 , N/A ,$107.10 ,$28.06 ,$35.28 ,$113.40 ,$26.10 ,$13.05 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200932,86738,HC MYCOPLASMA AB-90,302,1 ,$679.00 ,$441.35 ,$13.24 ,$679.00 ,$441.35 ,$13.24 ,$190.12 ,$343.57 ,$13.24 ,$390.43 ,$13.24 ,$343.51 ,$13.24 ,$25.16 ,$556.78 ,$33.10 ,$13.24 ,$577.15 ,$611.10 ,$13.24 ,$509.25 ,$475.30 ,$502.46 ,$502.46 ,$33.10 ,$577.15 ,$13.24 ,$13.24 ,$475.98 ,$13.24 ,$282.46 , N/A ,$577.15 ,$28.47 ,$190.12 ,$611.10 ,$26.48 ,$13.24 ,$441.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200935,86747,HC PARVOVIRUS AB-90,302,1 ,$139.00 ,$90.35 ,$15.03 ,$139.00 ,$90.35 ,$15.03 ,$38.92 ,$70.33 ,$15.03 ,$79.93 ,$15.03 ,$70.32 ,$15.03 ,$28.56 ,$113.98 ,$37.58 ,$15.03 ,$118.15 ,$125.10 ,$15.03 ,$104.25 ,$97.30 ,$102.86 ,$102.86 ,$37.58 ,$118.15 ,$15.03 ,$15.03 ,$97.44 ,$15.03 ,$57.82 , N/A ,$118.15 ,$32.31 ,$38.92 ,$125.10 ,$30.06 ,$15.03 ,$90.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200937,86753,HC PROTOZOA AB-90,302,1 ,$118.00 ,$76.70 ,$12.39 ,$118.00 ,$76.70 ,$12.39 ,$33.04 ,$59.71 ,$12.39 ,$67.85 ,$12.39 ,$59.70 ,$12.39 ,$23.54 ,$96.76 ,$30.98 ,$12.39 ,$100.30 ,$106.20 ,$12.39 ,$88.50 ,$82.60 ,$87.32 ,$87.32 ,$30.98 ,$100.30 ,$12.39 ,$12.39 ,$82.72 ,$12.39 ,$49.09 , N/A ,$100.30 ,$26.64 ,$33.04 ,$106.20 ,$24.78 ,$12.39 ,$76.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200939,86757,HC RICKETTSIA AB-90,302,1 ,$59.00 ,$38.35 ,$16.52 ,$59.00 ,$38.35 ,$19.35 ,$16.52 ,$29.85 ,$19.35 ,$33.93 ,$19.35 ,$29.85 ,$19.35 ,$36.77 ,$48.38 ,$48.38 ,$19.35 ,$50.15 ,$53.10 ,$19.35 ,$44.25 ,$41.30 ,$43.66 ,$43.66 ,$48.38 ,$50.15 ,$19.35 ,$19.35 ,$41.36 ,$19.35 ,$24.54 , N/A ,$50.15 ,$41.60 ,$16.52 ,$53.10 ,$38.70 ,$19.35 ,$38.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200940,86762,HC RUBELLA AB-90,302,1 ,$115.00 ,$74.75 ,$14.39 ,$115.00 ,$74.75 ,$14.39 ,$32.20 ,$58.19 ,$14.39 ,$66.13 ,$14.39 ,$58.18 ,$14.39 ,$27.34 ,$94.30 ,$35.98 ,$14.39 ,$97.75 ,$103.50 ,$14.39 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$35.98 ,$97.75 ,$14.39 ,$14.39 ,$80.62 ,$14.39 ,$47.84 , N/A ,$97.75 ,$30.94 ,$32.20 ,$103.50 ,$28.78 ,$14.39 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200941,86765,HC RUBEOLA AB-90,302,1 ,$155.00 ,$100.75 ,$12.88 ,$155.00 ,$100.75 ,$12.88 ,$43.40 ,$78.43 ,$12.88 ,$89.13 ,$12.88 ,$78.41 ,$12.88 ,$24.47 ,$127.10 ,$32.20 ,$12.88 ,$131.75 ,$139.50 ,$12.88 ,$116.25 ,$108.50 ,$114.70 ,$114.70 ,$32.20 ,$131.75 ,$12.88 ,$12.88 ,$108.66 ,$12.88 ,$64.48 , N/A ,$131.75 ,$27.69 ,$43.40 ,$139.50 ,$25.76 ,$12.88 ,$100.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200943,86774,HC TETANUS AB-90,302,1 ,$132.00 ,$85.80 ,$14.80 ,$132.00 ,$85.80 ,$14.80 ,$36.96 ,$66.79 ,$14.80 ,$75.90 ,$14.80 ,$66.78 ,$14.80 ,$28.12 ,$108.24 ,$37.00 ,$14.80 ,$112.20 ,$118.80 ,$14.80 ,$99.00 ,$92.40 ,$97.68 ,$97.68 ,$37.00 ,$112.20 ,$14.80 ,$14.80 ,$92.53 ,$14.80 ,$54.91 , N/A ,$112.20 ,$31.82 ,$36.96 ,$118.80 ,$29.60 ,$14.80 ,$85.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200944,86777,HC TOXOPLASMA AB-90,302,1 ,$115.00 ,$74.75 ,$14.39 ,$115.00 ,$74.75 ,$14.39 ,$32.20 ,$58.19 ,$14.39 ,$66.13 ,$14.39 ,$58.18 ,$14.39 ,$27.34 ,$94.30 ,$35.98 ,$14.39 ,$97.75 ,$103.50 ,$14.39 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$35.98 ,$97.75 ,$14.39 ,$14.39 ,$80.62 ,$14.39 ,$47.84 , N/A ,$97.75 ,$30.94 ,$32.20 ,$103.50 ,$28.78 ,$14.39 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200945,86778,HC TOXOPLASMA AB IGM-90,302,1 ,$115.00 ,$74.75 ,$14.41 ,$115.00 ,$74.75 ,$14.41 ,$32.20 ,$58.19 ,$14.41 ,$66.13 ,$14.41 ,$58.18 ,$14.41 ,$27.38 ,$94.30 ,$36.03 ,$14.41 ,$97.75 ,$103.50 ,$14.41 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$36.03 ,$97.75 ,$14.41 ,$14.41 ,$80.62 ,$14.41 ,$47.84 , N/A ,$97.75 ,$30.98 ,$32.20 ,$103.50 ,$28.82 ,$14.41 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200946,86780,HC TREPONEMA P AB CONFIRM-90,302,1 ,$168.00 ,$109.20 ,$13.24 ,$168.00 ,$109.20 ,$13.24 ,$47.04 ,$85.01 ,$13.24 ,$96.60 ,$13.24 ,$84.99 ,$13.24 ,$25.16 ,$137.76 ,$33.10 ,$13.24 ,$142.80 ,$151.20 ,$13.24 ,$126.00 ,$117.60 ,$124.32 ,$124.32 ,$33.10 ,$142.80 ,$13.24 ,$13.24 ,$117.77 ,$13.24 ,$69.89 , N/A ,$142.80 ,$28.47 ,$47.04 ,$151.20 ,$26.48 ,$13.24 ,$109.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200948,86787,HC VARICELLA ZOSTER AB-90,302,1 ,$295.00 ,$191.75 ,$12.88 ,$295.00 ,$191.75 ,$12.88 ,$82.60 ,$149.27 ,$12.88 ,$169.63 ,$12.88 ,$149.24 ,$12.88 ,$24.47 ,$241.90 ,$32.20 ,$12.88 ,$250.75 ,$265.50 ,$12.88 ,$221.25 ,$206.50 ,$218.30 ,$218.30 ,$32.20 ,$250.75 ,$12.88 ,$12.88 ,$206.80 ,$12.88 ,$122.72 , N/A ,$250.75 ,$27.69 ,$82.60 ,$265.50 ,$25.76 ,$12.88 ,$191.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200950,86789,HC WEST NILE AB-90,302,1 ,$104.00 ,$67.60 ,$14.39 ,$104.00 ,$67.60 ,$14.39 ,$29.12 ,$52.62 ,$14.39 ,$59.80 ,$14.39 ,$52.61 ,$14.39 ,$27.34 ,$85.28 ,$35.98 ,$14.39 ,$88.40 ,$93.60 ,$14.39 ,$78.00 ,$72.80 ,$76.96 ,$76.96 ,$35.98 ,$88.40 ,$14.39 ,$14.39 ,$72.90 ,$14.39 ,$43.26 , N/A ,$88.40 ,$30.94 ,$29.12 ,$93.60 ,$28.78 ,$14.39 ,$67.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200951,86790,HC VIRUS AB NOT SPECIFIED-90,302,1 ,$185.00 ,$120.25 ,$12.88 ,$185.00 ,$120.25 ,$12.88 ,$51.80 ,$93.61 ,$12.88 ,$106.38 ,$12.88 ,$93.59 ,$12.88 ,$24.47 ,$151.70 ,$32.20 ,$12.88 ,$157.25 ,$166.50 ,$12.88 ,$138.75 ,$129.50 ,$136.90 ,$136.90 ,$32.20 ,$157.25 ,$12.88 ,$12.88 ,$129.69 ,$12.88 ,$76.96 , N/A ,$157.25 ,$27.69 ,$51.80 ,$166.50 ,$25.76 ,$12.88 ,$120.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200953,86800,HC THYROGLOBULIN AB-90,302,1 ,$25.00 ,$16.25 ,$7.00 ,$39.78 ,$16.25 ,$15.91 ,$7.00 ,$12.65 ,$15.91 ,$14.38 ,$15.91 ,$12.65 ,$15.91 ,$25.00 ,$20.50 ,$39.78 ,$15.91 ,$21.25 ,$22.50 ,$15.91 ,$18.75 ,$17.50 ,$18.50 ,$18.50 ,$25.00 ,$21.25 ,$15.91 ,$15.91 ,$17.53 ,$15.91 ,$10.40 , N/A ,$21.25 ,$34.21 ,$7.00 ,$22.50 ,$25.00 ,$15.91 ,$16.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200960,86812,HC HLA TYPING SINGLE A/B/C-90,302,1 ,$390.00 ,$253.50 ,$25.81 ,$390.00 ,$253.50 ,$25.81 ,$109.20 ,$197.34 ,$25.81 ,$224.25 ,$25.81 ,$197.30 ,$25.81 ,$49.04 ,$319.80 ,$64.53 ,$25.81 ,$331.50 ,$351.00 ,$25.81 ,$292.50 ,$273.00 ,$288.60 ,$288.60 ,$64.53 ,$331.50 ,$25.81 ,$25.81 ,$273.39 ,$25.81 ,$162.24 , N/A ,$331.50 ,$55.49 ,$109.20 ,$351.00 ,$51.62 ,$25.81 ,$253.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200966,86850,HC AB SCREEN-90,302,1 ,$115.00 ,$74.75 ,$19.54 ,$122.48 ,$74.75 ,$48.99 ,$32.20 ,$58.19 ,$48.99 ,$66.13 ,$48.99 ,$58.18 ,$48.99 ,$93.08 ,$94.30 ,$122.48 ,$48.99 ,$97.75 ,$103.50 ,$48.99 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$115.00 ,$97.75 ,$48.99 ,$48.99 ,$80.62 ,$48.99 ,$47.84 , N/A ,$97.75 ,$105.33 ,$32.20 ,$103.50 ,$19.54 ,$48.99 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200970,86860,HC ELUTION-90,302,1 ,$115.00 ,$74.75 ,$32.20 ,$367.59 ,$74.75 ,$147.04 ,$32.20 ,$58.19 ,$147.04 ,$66.13 ,$115.00 ,$58.18 ,$115.00 ,$115.00 ,$94.30 ,$367.59 ,$147.04 ,$97.75 ,$103.50 ,$147.04 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$115.00 ,$97.75 ,$147.04 ,$147.04 ,$80.62 ,$147.04 ,$47.84 , N/A ,$97.75 ,$316.13 ,$32.20 ,$103.50 ,$115.00 ,$147.04 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200974,86870,HC RBC AB ID PANEL-90,302,1 ,$216.00 ,$140.40 ,$60.48 ,$717.84 ,$140.40 ,$287.13 ,$60.48 ,$109.30 ,$287.13 ,$124.20 ,$216.00 ,$109.27 ,$216.00 ,$216.00 ,$177.12 ,$717.84 ,$287.13 ,$183.60 ,$194.40 ,$287.13 ,$162.00 ,$151.20 ,$159.84 ,$159.84 ,$216.00 ,$183.60 ,$287.13 ,$287.13 ,$151.42 ,$287.13 ,$89.86 , N/A ,$183.60 ,$617.34 ,$60.48 ,$194.40 ,$216.00 ,$287.13 ,$140.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200976,86880,HC COOMBS DIRECT-90,302,1 ,$104.00 ,$67.60 ,$10.78 ,$137.20 ,$67.60 ,$54.88 ,$29.12 ,$52.62 ,$54.88 ,$59.80 ,$54.88 ,$52.61 ,$54.88 ,$104.00 ,$85.28 ,$137.20 ,$54.88 ,$88.40 ,$93.60 ,$54.88 ,$78.00 ,$72.80 ,$76.96 ,$76.96 ,$104.00 ,$88.40 ,$54.88 ,$54.88 ,$72.90 ,$54.88 ,$43.26 , N/A ,$88.40 ,$117.99 ,$29.12 ,$93.60 ,$10.78 ,$54.88 ,$67.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200978,86886,HC INDIRECT TITER-90,302,1 ,$232.00 ,$150.80 ,$10.36 ,$367.59 ,$150.80 ,$147.04 ,$64.96 ,$117.39 ,$147.04 ,$133.40 ,$147.04 ,$117.37 ,$147.04 ,$232.00 ,$190.24 ,$367.59 ,$147.04 ,$197.20 ,$208.80 ,$147.04 ,$174.00 ,$162.40 ,$171.68 ,$171.68 ,$232.00 ,$197.20 ,$147.04 ,$147.04 ,$162.63 ,$147.04 ,$96.51 , N/A ,$197.20 ,$316.13 ,$64.96 ,$208.80 ,$10.36 ,$147.04 ,$150.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200981,86900,HC BLOOD TYPING ABO-90,302,1 ,$76.00 ,$49.40 ,$5.98 ,$277.92 ,$49.40 ,$111.17 ,$21.28 ,$38.46 ,$111.17 ,$43.70 ,$76.00 ,$38.45 ,$76.00 ,$76.00 ,$62.32 ,$277.92 ,$111.17 ,$64.60 ,$68.40 ,$111.17 ,$57.00 ,$53.20 ,$56.24 ,$56.24 ,$76.00 ,$64.60 ,$111.17 ,$111.17 ,$53.28 ,$111.17 ,$31.62 , N/A ,$64.60 ,$239.01 ,$21.28 ,$68.40 ,$5.98 ,$111.17 ,$49.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200983,86901,HC BLOOD TYPING RH-90,302,1 ,$76.00 ,$49.40 ,$5.98 ,$83.43 ,$49.40 ,$33.37 ,$21.28 ,$38.46 ,$33.37 ,$43.70 ,$33.37 ,$38.45 ,$33.37 ,$63.41 ,$62.32 ,$83.43 ,$33.37 ,$64.60 ,$68.40 ,$33.37 ,$57.00 ,$53.20 ,$56.24 ,$56.24 ,$76.00 ,$64.60 ,$33.37 ,$33.37 ,$53.28 ,$33.37 ,$31.62 , N/A ,$64.60 ,$71.75 ,$21.28 ,$68.40 ,$5.98 ,$33.37 ,$49.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200990,86904,HC RBC AG SCR PAT SERUM-90,302,1 ,$77.00 ,$50.05 ,$21.56 ,$83.43 ,$50.05 ,$33.37 ,$21.56 ,$38.96 ,$33.37 ,$44.28 ,$33.37 ,$38.95 ,$33.37 ,$63.41 ,$63.14 ,$83.43 ,$33.37 ,$65.45 ,$69.30 ,$33.37 ,$57.75 ,$53.90 ,$56.98 ,$56.98 ,$77.00 ,$65.45 ,$33.37 ,$33.37 ,$53.98 ,$33.37 ,$32.03 , N/A ,$65.45 ,$71.75 ,$21.56 ,$69.30 ,$32.68 ,$33.37 ,$50.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30200998,86906,HC RH PHENOTYPE COMPLETE-90,302,1 ,$115.00 ,$74.75 ,$15.50 ,$115.00 ,$74.75 ,$33.37 ,$32.20 ,$58.19 ,$33.37 ,$66.13 ,$33.37 ,$58.18 ,$33.37 ,$63.41 ,$94.30 ,$83.43 ,$33.37 ,$97.75 ,$103.50 ,$33.37 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$83.43 ,$97.75 ,$33.37 ,$33.37 ,$80.62 ,$33.37 ,$47.84 , N/A ,$97.75 ,$71.75 ,$32.20 ,$103.50 ,$15.50 ,$33.37 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201000,86922,HC CROSSMATCH AHG-90,302,1 ,$93.00 ,$60.45 ,$26.04 ,$367.59 ,$60.45 ,$147.04 ,$26.04 ,$47.06 ,$147.04 ,$53.48 ,$93.00 ,$47.05 ,$93.00 ,$93.00 ,$76.26 ,$367.59 ,$147.04 ,$79.05 ,$83.70 ,$147.04 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$93.00 ,$79.05 ,$147.04 ,$147.04 ,$65.19 ,$147.04 ,$38.69 , N/A ,$79.05 ,$316.13 ,$26.04 ,$83.70 ,$93.00 ,$147.04 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201003,86970,HC RBC PRETREAT CHEM-90,302,1 ,$205.00 ,$133.25 ,$33.37 ,$205.00 ,$133.25 ,$33.37 ,$57.40 ,$103.73 ,$33.37 ,$117.88 ,$33.37 ,$103.71 ,$33.37 ,$63.41 ,$168.10 ,$83.43 ,$33.37 ,$174.25 ,$184.50 ,$33.37 ,$153.75 ,$143.50 ,$151.70 ,$151.70 ,$83.43 ,$174.25 ,$33.37 ,$33.37 ,$143.71 ,$33.37 ,$85.28 , N/A ,$174.25 ,$71.75 ,$57.40 ,$184.50 ,$67.68 ,$33.37 ,$133.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201005,86971,HC RBC PRETREAT ENZYME-90,302,1 ,$101.00 ,$65.65 ,$28.28 ,$717.84 ,$65.65 ,$287.13 ,$28.28 ,$51.11 ,$287.13 ,$58.08 ,$101.00 ,$51.10 ,$101.00 ,$101.00 ,$82.82 ,$717.84 ,$287.13 ,$85.85 ,$90.90 ,$287.13 ,$75.75 ,$70.70 ,$74.74 ,$74.74 ,$101.00 ,$85.85 ,$287.13 ,$287.13 ,$70.80 ,$287.13 ,$42.02 , N/A ,$85.85 ,$617.34 ,$28.28 ,$90.90 ,$101.00 ,$287.13 ,$65.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201007,86972,HC RBC PRETREAT DENSITY SEP-90,302,1 ,$143.00 ,$92.95 ,$40.04 ,$367.59 ,$92.95 ,$147.04 ,$40.04 ,$72.36 ,$147.04 ,$82.23 ,$143.00 ,$72.34 ,$143.00 ,$143.00 ,$117.26 ,$367.59 ,$147.04 ,$121.55 ,$128.70 ,$147.04 ,$107.25 ,$100.10 ,$105.82 ,$105.82 ,$143.00 ,$121.55 ,$147.04 ,$147.04 ,$100.24 ,$147.04 ,$59.49 , N/A ,$121.55 ,$316.13 ,$40.04 ,$128.70 ,$143.00 ,$147.04 ,$92.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201020,86978,HC RBC PRETREAT ABSOR-90,302,1 ,$206.00 ,$133.90 ,$33.37 ,$206.00 ,$133.90 ,$33.37 ,$57.68 ,$104.24 ,$33.37 ,$118.45 ,$33.37 ,$104.22 ,$33.37 ,$63.41 ,$168.92 ,$83.43 ,$33.37 ,$175.10 ,$185.40 ,$33.37 ,$154.50 ,$144.20 ,$152.44 ,$152.44 ,$83.43 ,$175.10 ,$33.37 ,$33.37 ,$144.41 ,$33.37 ,$85.70 , N/A ,$175.10 ,$71.75 ,$57.68 ,$185.40 ,$67.68 ,$33.37 ,$133.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201025,86316,HC TUMOR AG OTHER AG QN-90,302,1 ,$444.00 ,$288.60 ,$20.81 ,$444.00 ,$288.60 ,$20.81 ,$124.32 ,$224.66 ,$20.81 ,$255.30 ,$20.81 ,$224.62 ,$20.81 ,$39.54 ,$364.08 ,$52.03 ,$20.81 ,$377.40 ,$399.60 ,$20.81 ,$333.00 ,$310.80 ,$328.56 ,$328.56 ,$52.03 ,$377.40 ,$20.81 ,$20.81 ,$311.24 ,$20.81 ,$184.70 , N/A ,$377.40 ,$44.74 ,$124.32 ,$399.60 ,$41.62 ,$20.81 ,$288.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201026,86317,HC INFECTIOUS AB QN-90,302,1 ,$273.70 ,$177.91 ,$14.99 ,$273.70 ,$177.91 ,$14.99 ,$76.64 ,$138.49 ,$14.99 ,$157.38 ,$14.99 ,$138.46 ,$14.99 ,$28.48 ,$224.43 ,$37.48 ,$14.99 ,$232.65 ,$246.33 ,$14.99 ,$205.28 ,$191.59 ,$202.54 ,$202.54 ,$37.48 ,$232.65 ,$14.99 ,$14.99 ,$191.86 ,$14.99 ,$113.86 , N/A ,$232.65 ,$32.23 ,$76.64 ,$246.33 ,$29.98 ,$14.99 ,$177.91 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201029,86331,HC IMMUNODIFF EL EA AG AB QL-90,302,1 ,$40.00 ,$26.00 ,$11.20 ,$40.00 ,$26.00 ,$11.98 ,$11.20 ,$20.24 ,$11.98 ,$23.00 ,$11.98 ,$20.24 ,$11.98 ,$22.76 ,$32.80 ,$29.95 ,$11.98 ,$34.00 ,$36.00 ,$11.98 ,$30.00 ,$28.00 ,$29.60 ,$29.60 ,$29.95 ,$34.00 ,$11.98 ,$11.98 ,$28.04 ,$11.98 ,$16.64 , N/A ,$34.00 ,$25.76 ,$11.20 ,$36.00 ,$23.96 ,$11.98 ,$26.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201030,86332,HC IMMUNE COMPLEX ASSAY-90,302,1 ,$52.00 ,$33.80 ,$14.56 ,$60.93 ,$33.80 ,$24.37 ,$14.56 ,$26.31 ,$24.37 ,$29.90 ,$24.37 ,$26.31 ,$24.37 ,$46.30 ,$42.64 ,$60.93 ,$24.37 ,$44.20 ,$46.80 ,$24.37 ,$39.00 ,$36.40 ,$38.48 ,$38.48 ,$52.00 ,$44.20 ,$24.37 ,$24.37 ,$36.45 ,$24.37 ,$21.63 , N/A ,$44.20 ,$52.40 ,$14.56 ,$46.80 ,$48.74 ,$24.37 ,$33.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201031,86334,HC IMMUNOFIX ELECTRO SERUM -90,302,1 ,$164.00 ,$106.60 ,$22.34 ,$164.00 ,$106.60 ,$22.34 ,$45.92 ,$82.98 ,$22.34 ,$94.30 ,$22.34 ,$82.97 ,$22.34 ,$42.45 ,$134.48 ,$55.85 ,$22.34 ,$139.40 ,$147.60 ,$22.34 ,$123.00 ,$114.80 ,$121.36 ,$121.36 ,$55.85 ,$139.40 ,$22.34 ,$22.34 ,$114.96 ,$22.34 ,$68.22 , N/A ,$139.40 ,$48.03 ,$45.92 ,$147.60 ,$44.68 ,$22.34 ,$106.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201032,86335,HC IMMUNOFIX ELECTRO OTH-90,302,1 ,$137.00 ,$89.05 ,$29.35 ,$137.00 ,$89.05 ,$29.35 ,$38.36 ,$69.32 ,$29.35 ,$78.78 ,$29.35 ,$69.31 ,$29.35 ,$55.77 ,$112.34 ,$73.38 ,$29.35 ,$116.45 ,$123.30 ,$29.35 ,$102.75 ,$95.90 ,$101.38 ,$101.38 ,$73.38 ,$116.45 ,$29.35 ,$29.35 ,$96.04 ,$29.35 ,$56.99 , N/A ,$116.45 ,$63.10 ,$38.36 ,$123.30 ,$58.70 ,$29.35 ,$89.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201033,86336,HC INHIBIN A-90,302,1 ,$156.00 ,$101.40 ,$15.59 ,$156.00 ,$101.40 ,$15.59 ,$43.68 ,$78.94 ,$15.59 ,$89.70 ,$15.59 ,$78.92 ,$15.59 ,$29.62 ,$127.92 ,$38.98 ,$15.59 ,$132.60 ,$140.40 ,$15.59 ,$117.00 ,$109.20 ,$115.44 ,$115.44 ,$38.98 ,$132.60 ,$15.59 ,$15.59 ,$109.36 ,$15.59 ,$64.90 , N/A ,$132.60 ,$33.52 ,$43.68 ,$140.40 ,$31.18 ,$15.59 ,$101.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201034,86337,HC INSULIN AB-90,302,1 ,$154.00 ,$100.10 ,$21.41 ,$154.00 ,$100.10 ,$21.41 ,$43.12 ,$77.92 ,$21.41 ,$88.55 ,$21.41 ,$77.91 ,$21.41 ,$40.68 ,$126.28 ,$53.53 ,$21.41 ,$130.90 ,$138.60 ,$21.41 ,$115.50 ,$107.80 ,$113.96 ,$113.96 ,$53.53 ,$130.90 ,$21.41 ,$21.41 ,$107.95 ,$21.41 ,$64.06 , N/A ,$130.90 ,$46.03 ,$43.12 ,$138.60 ,$42.82 ,$21.41 ,$100.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201035,86340,HC INTRINSIC FACTOR AB-90,302,1 ,$97.00 ,$63.05 ,$15.08 ,$97.00 ,$63.05 ,$15.08 ,$27.16 ,$49.08 ,$15.08 ,$55.78 ,$15.08 ,$49.07 ,$15.08 ,$28.65 ,$79.54 ,$37.70 ,$15.08 ,$82.45 ,$87.30 ,$15.08 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$37.70 ,$82.45 ,$15.08 ,$15.08 ,$68.00 ,$15.08 ,$40.35 , N/A ,$82.45 ,$32.42 ,$27.16 ,$87.30 ,$30.16 ,$15.08 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201036,86341,HC ISLET CELL AB-90,302,1 ,$62.00 ,$40.30 ,$17.36 ,$62.00 ,$40.30 ,$23.57 ,$17.36 ,$31.37 ,$23.57 ,$35.65 ,$23.57 ,$31.37 ,$23.57 ,$44.78 ,$50.84 ,$58.93 ,$23.57 ,$52.70 ,$55.80 ,$23.57 ,$46.50 ,$43.40 ,$45.88 ,$45.88 ,$58.93 ,$52.70 ,$23.57 ,$23.57 ,$43.46 ,$23.57 ,$25.79 , N/A ,$52.70 ,$50.68 ,$17.36 ,$55.80 ,$47.14 ,$23.57 ,$40.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201037,86343,HC LEUKOCYTE HISTAMINE RELEASE-90,302,1 ,$277.00 ,$180.05 ,$12.46 ,$277.00 ,$180.05 ,$12.46 ,$77.56 ,$140.16 ,$12.46 ,$159.28 ,$12.46 ,$140.13 ,$12.46 ,$23.67 ,$227.14 ,$31.15 ,$12.46 ,$235.45 ,$249.30 ,$12.46 ,$207.75 ,$193.90 ,$204.98 ,$204.98 ,$31.15 ,$235.45 ,$12.46 ,$12.46 ,$194.18 ,$12.46 ,$115.23 , N/A ,$235.45 ,$26.79 ,$77.56 ,$249.30 ,$24.92 ,$12.46 ,$180.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201040,86355,HC B CELLS TOTAL COUNT-90,302,1 ,$206.00 ,$133.90 ,$37.73 ,$206.00 ,$133.90 ,$37.73 ,$57.68 ,$104.24 ,$37.73 ,$118.45 ,$37.73 ,$104.22 ,$37.73 ,$71.69 ,$168.92 ,$94.33 ,$37.73 ,$175.10 ,$185.40 ,$37.73 ,$154.50 ,$144.20 ,$152.44 ,$152.44 ,$94.33 ,$175.10 ,$37.73 ,$37.73 ,$144.41 ,$37.73 ,$85.70 , N/A ,$175.10 ,$81.12 ,$57.68 ,$185.40 ,$75.46 ,$37.73 ,$133.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201042,86357,HC CD8 TOTAL COUNT-90,302,1 ,$201.00 ,$130.65 ,$37.73 ,$201.00 ,$130.65 ,$37.73 ,$56.28 ,$101.71 ,$37.73 ,$115.58 ,$37.73 ,$101.69 ,$37.73 ,$71.69 ,$164.82 ,$94.33 ,$37.73 ,$170.85 ,$180.90 ,$37.73 ,$150.75 ,$140.70 ,$148.74 ,$148.74 ,$94.33 ,$170.85 ,$37.73 ,$37.73 ,$140.90 ,$37.73 ,$83.62 , N/A ,$170.85 ,$81.12 ,$56.28 ,$180.90 ,$75.46 ,$37.73 ,$130.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201043,86359,HC T CELLS TOTAL COUNT-90,302,1 ,$130.00 ,$84.50 ,$36.40 ,$130.00 ,$84.50 ,$37.73 ,$36.40 ,$65.78 ,$37.73 ,$74.75 ,$37.73 ,$65.77 ,$37.73 ,$71.69 ,$106.60 ,$94.33 ,$37.73 ,$110.50 ,$117.00 ,$37.73 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$94.33 ,$110.50 ,$37.73 ,$37.73 ,$91.13 ,$37.73 ,$54.08 , N/A ,$110.50 ,$81.12 ,$36.40 ,$117.00 ,$75.46 ,$37.73 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201045,86360,HC ABS T CELLS CD4 CD8 RATIO-90,302,1 ,$161.00 ,$104.65 ,$45.08 ,$161.00 ,$104.65 ,$46.98 ,$45.08 ,$81.47 ,$46.98 ,$92.58 ,$46.98 ,$81.45 ,$46.98 ,$89.26 ,$132.02 ,$117.45 ,$46.98 ,$136.85 ,$144.90 ,$46.98 ,$120.75 ,$112.70 ,$119.14 ,$119.14 ,$117.45 ,$136.85 ,$46.98 ,$46.98 ,$112.86 ,$46.98 ,$66.98 , N/A ,$136.85 ,$101.01 ,$45.08 ,$144.90 ,$93.96 ,$46.98 ,$104.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201047,86376,HC MICROSOMAL AB-90,302,1 ,$152.00 ,$98.80 ,$14.55 ,$152.00 ,$98.80 ,$14.55 ,$42.56 ,$76.91 ,$14.55 ,$87.40 ,$14.55 ,$76.90 ,$14.55 ,$27.65 ,$124.64 ,$36.38 ,$14.55 ,$129.20 ,$136.80 ,$14.55 ,$114.00 ,$106.40 ,$112.48 ,$112.48 ,$36.38 ,$129.20 ,$14.55 ,$14.55 ,$106.55 ,$14.55 ,$63.23 , N/A ,$129.20 ,$31.28 ,$42.56 ,$136.80 ,$29.10 ,$14.55 ,$98.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201048,86382,HC NEUTRALIZATION TEST VIRAL-90,302,1 ,$216.00 ,$140.40 ,$16.91 ,$216.00 ,$140.40 ,$16.91 ,$60.48 ,$109.30 ,$16.91 ,$124.20 ,$16.91 ,$109.27 ,$16.91 ,$32.13 ,$177.12 ,$42.28 ,$16.91 ,$183.60 ,$194.40 ,$16.91 ,$162.00 ,$151.20 ,$159.84 ,$159.84 ,$42.28 ,$183.60 ,$16.91 ,$16.91 ,$151.42 ,$16.91 ,$89.86 , N/A ,$183.60 ,$36.36 ,$60.48 ,$194.40 ,$33.82 ,$16.91 ,$140.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201052,86431,HC RHEUMATOID FACTOR QN-90,302,1 ,$97.00 ,$63.05 ,$5.67 ,$97.00 ,$63.05 ,$5.67 ,$27.16 ,$49.08 ,$5.67 ,$55.78 ,$5.67 ,$49.07 ,$5.67 ,$10.77 ,$79.54 ,$14.18 ,$5.67 ,$82.45 ,$87.30 ,$5.67 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$14.18 ,$82.45 ,$5.67 ,$5.67 ,$68.00 ,$5.67 ,$40.35 , N/A ,$82.45 ,$12.19 ,$27.16 ,$87.30 ,$11.34 ,$5.67 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201053,86480,HC TB QUANTIFERON GOLD-90,302,1 ,$113.00 ,$73.45 ,$31.64 ,$154.95 ,$73.45 ,$61.98 ,$31.64 ,$57.18 ,$61.98 ,$64.98 ,$61.98 ,$57.17 ,$61.98 ,$113.00 ,$92.66 ,$154.95 ,$61.98 ,$96.05 ,$101.70 ,$61.98 ,$84.75 ,$79.10 ,$83.62 ,$83.62 ,$113.00 ,$96.05 ,$61.98 ,$61.98 ,$79.21 ,$61.98 ,$47.01 , N/A ,$96.05 ,$133.26 ,$31.64 ,$101.70 ,$113.00 ,$61.98 ,$73.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201054,86592,HC SYPHILIS VDRL RPR QL-90,302,1 ,$140.00 ,$91.00 ,$4.27 ,$140.00 ,$91.00 ,$4.27 ,$39.20 ,$70.84 ,$4.27 ,$80.50 ,$4.27 ,$70.83 ,$4.27 ,$8.11 ,$114.80 ,$10.68 ,$4.27 ,$119.00 ,$126.00 ,$4.27 ,$105.00 ,$98.00 ,$103.60 ,$103.60 ,$10.68 ,$119.00 ,$4.27 ,$4.27 ,$98.14 ,$4.27 ,$58.24 , N/A ,$119.00 ,$9.18 ,$39.20 ,$126.00 ,$8.54 ,$4.27 ,$91.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201056,86606,HC ASPERGILLUS AB-90,302,1 ,$154.00 ,$100.10 ,$15.05 ,$154.00 ,$100.10 ,$15.05 ,$43.12 ,$77.92 ,$15.05 ,$88.55 ,$15.05 ,$77.91 ,$15.05 ,$28.60 ,$126.28 ,$37.63 ,$15.05 ,$130.90 ,$138.60 ,$15.05 ,$115.50 ,$107.80 ,$113.96 ,$113.96 ,$37.63 ,$130.90 ,$15.05 ,$15.05 ,$107.95 ,$15.05 ,$64.06 , N/A ,$130.90 ,$32.36 ,$43.12 ,$138.60 ,$30.10 ,$15.05 ,$100.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201057,86609,HC BACTERIUM AB NOS-90,302,1 ,$90.00 ,$58.50 ,$12.88 ,$90.00 ,$58.50 ,$12.88 ,$25.20 ,$45.54 ,$12.88 ,$51.75 ,$12.88 ,$45.53 ,$12.88 ,$24.47 ,$73.80 ,$32.20 ,$12.88 ,$76.50 ,$81.00 ,$12.88 ,$67.50 ,$63.00 ,$66.60 ,$66.60 ,$32.20 ,$76.50 ,$12.88 ,$12.88 ,$63.09 ,$12.88 ,$37.44 , N/A ,$76.50 ,$27.69 ,$25.20 ,$81.00 ,$25.76 ,$12.88 ,$58.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201058,86611,HC BARTONELLA SCREEN AB-90,302,1 ,$98.00 ,$63.70 ,$10.18 ,$98.00 ,$63.70 ,$10.18 ,$27.44 ,$49.59 ,$10.18 ,$56.35 ,$10.18 ,$49.58 ,$10.18 ,$19.34 ,$80.36 ,$25.45 ,$10.18 ,$83.30 ,$88.20 ,$10.18 ,$73.50 ,$68.60 ,$72.52 ,$72.52 ,$25.45 ,$83.30 ,$10.18 ,$10.18 ,$68.70 ,$10.18 ,$40.77 , N/A ,$83.30 ,$21.89 ,$27.44 ,$88.20 ,$20.36 ,$10.18 ,$63.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201060,86612,HC BLASTOMYCES AB-90,302,1 ,$71.00 ,$46.15 ,$12.90 ,$71.00 ,$46.15 ,$12.90 ,$19.88 ,$35.93 ,$12.90 ,$40.83 ,$12.90 ,$35.92 ,$12.90 ,$24.51 ,$58.22 ,$32.25 ,$12.90 ,$60.35 ,$63.90 ,$12.90 ,$53.25 ,$49.70 ,$52.54 ,$52.54 ,$32.25 ,$60.35 ,$12.90 ,$12.90 ,$49.77 ,$12.90 ,$29.54 , N/A ,$60.35 ,$27.74 ,$19.88 ,$63.90 ,$25.80 ,$12.90 ,$46.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201061,86615,HC BORDETELLA AB-90,302,1 ,$107.00 ,$69.55 ,$13.19 ,$107.00 ,$69.55 ,$13.19 ,$29.96 ,$54.14 ,$13.19 ,$61.53 ,$13.19 ,$54.13 ,$13.19 ,$25.06 ,$87.74 ,$32.98 ,$13.19 ,$90.95 ,$96.30 ,$13.19 ,$80.25 ,$74.90 ,$79.18 ,$79.18 ,$32.98 ,$90.95 ,$13.19 ,$13.19 ,$75.01 ,$13.19 ,$44.51 , N/A ,$90.95 ,$28.36 ,$29.96 ,$96.30 ,$26.38 ,$13.19 ,$69.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201062,86617,HC LYME DISEASE AB CONFIRM-90,302,1 ,$59.00 ,$38.35 ,$15.49 ,$59.00 ,$38.35 ,$15.49 ,$16.52 ,$29.85 ,$15.49 ,$33.93 ,$15.49 ,$29.85 ,$15.49 ,$29.43 ,$48.38 ,$38.73 ,$15.49 ,$50.15 ,$53.10 ,$15.49 ,$44.25 ,$41.30 ,$43.66 ,$43.66 ,$38.73 ,$50.15 ,$15.49 ,$15.49 ,$41.36 ,$15.49 ,$24.54 , N/A ,$50.15 ,$33.30 ,$16.52 ,$53.10 ,$30.98 ,$15.49 ,$38.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201063,86618,HC LYME AB-90,302,1 ,$226.00 ,$146.90 ,$17.03 ,$226.00 ,$146.90 ,$17.03 ,$63.28 ,$114.36 ,$17.03 ,$129.95 ,$17.03 ,$114.33 ,$17.03 ,$32.36 ,$185.32 ,$42.58 ,$17.03 ,$192.10 ,$203.40 ,$17.03 ,$169.50 ,$158.20 ,$167.24 ,$167.24 ,$42.58 ,$192.10 ,$17.03 ,$17.03 ,$158.43 ,$17.03 ,$94.02 , N/A ,$192.10 ,$36.61 ,$63.28 ,$203.40 ,$34.06 ,$17.03 ,$146.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201065,86622,HC BRUCELLA AB-90,302,1 ,$94.00 ,$61.10 ,$8.93 ,$94.00 ,$61.10 ,$8.93 ,$26.32 ,$47.56 ,$8.93 ,$54.05 ,$8.93 ,$47.55 ,$8.93 ,$16.97 ,$77.08 ,$22.33 ,$8.93 ,$79.90 ,$84.60 ,$8.93 ,$70.50 ,$65.80 ,$69.56 ,$69.56 ,$22.33 ,$79.90 ,$8.93 ,$8.93 ,$65.89 ,$8.93 ,$39.10 , N/A ,$79.90 ,$19.20 ,$26.32 ,$84.60 ,$17.86 ,$8.93 ,$61.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201067,86631,HC CHLAMYDIA AB-90,302,1 ,$102.00 ,$66.30 ,$11.82 ,$102.00 ,$66.30 ,$11.82 ,$28.56 ,$51.61 ,$11.82 ,$58.65 ,$11.82 ,$51.60 ,$11.82 ,$22.46 ,$83.64 ,$29.55 ,$11.82 ,$86.70 ,$91.80 ,$11.82 ,$76.50 ,$71.40 ,$75.48 ,$75.48 ,$29.55 ,$86.70 ,$11.82 ,$11.82 ,$71.50 ,$11.82 ,$42.43 , N/A ,$86.70 ,$25.41 ,$28.56 ,$91.80 ,$23.64 ,$11.82 ,$66.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201096,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$106.00 ,$68.90 ,$12.95 ,$106.00 ,$68.90 ,$12.95 ,$29.68 ,$53.64 ,$12.95 ,$60.95 ,$12.95 ,$53.63 ,$12.95 ,$24.61 ,$86.92 ,$32.38 ,$12.95 ,$90.10 ,$95.40 ,$12.95 ,$79.50 ,$74.20 ,$78.44 ,$78.44 ,$32.38 ,$90.10 ,$12.95 ,$12.95 ,$74.31 ,$12.95 ,$44.10 , N/A ,$90.10 ,$27.84 ,$29.68 ,$95.40 ,$25.90 ,$12.95 ,$68.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201108,86431,HC RHEUMATOID FACTOR QN,302,1 ,$97.00 ,$63.05 ,$5.67 ,$97.00 ,$63.05 ,$5.67 ,$27.16 ,$49.08 ,$5.67 ,$55.78 ,$5.67 ,$49.07 ,$5.67 ,$10.77 ,$79.54 ,$14.18 ,$5.67 ,$82.45 ,$87.30 ,$5.67 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$14.18 ,$82.45 ,$5.67 ,$5.67 ,$68.00 ,$5.67 ,$40.35 , N/A ,$82.45 ,$12.19 ,$27.16 ,$87.30 ,$11.34 ,$5.67 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201110,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$102.00 ,$66.30 ,$4.27 ,$102.00 ,$66.30 ,$4.27 ,$28.56 ,$51.61 ,$4.27 ,$58.65 ,$4.27 ,$51.60 ,$4.27 ,$8.11 ,$83.64 ,$10.68 ,$4.27 ,$86.70 ,$91.80 ,$4.27 ,$76.50 ,$71.40 ,$75.48 ,$75.48 ,$10.68 ,$86.70 ,$4.27 ,$4.27 ,$71.50 ,$4.27 ,$42.43 , N/A ,$86.70 ,$9.18 ,$28.56 ,$91.80 ,$8.54 ,$4.27 ,$66.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201121,86704,HC HEP CORE AB,302,1 ,$190.00 ,$123.50 ,$12.05 ,$190.00 ,$123.50 ,$12.05 ,$53.20 ,$96.14 ,$12.05 ,$109.25 ,$12.05 ,$96.12 ,$12.05 ,$22.90 ,$155.80 ,$30.13 ,$12.05 ,$161.50 ,$171.00 ,$12.05 ,$142.50 ,$133.00 ,$140.60 ,$140.60 ,$30.13 ,$161.50 ,$12.05 ,$12.05 ,$133.19 ,$12.05 ,$79.04 , N/A ,$161.50 ,$25.91 ,$53.20 ,$171.00 ,$24.10 ,$12.05 ,$123.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201122,86705,HC HEP B CORE IGM,302,1 ,$85.00 ,$55.25 ,$11.77 ,$85.00 ,$55.25 ,$11.77 ,$23.80 ,$43.01 ,$11.77 ,$48.88 ,$11.77 ,$43.00 ,$11.77 ,$22.36 ,$69.70 ,$29.43 ,$11.77 ,$72.25 ,$76.50 ,$11.77 ,$63.75 ,$59.50 ,$62.90 ,$62.90 ,$29.43 ,$72.25 ,$11.77 ,$11.77 ,$59.59 ,$11.77 ,$35.36 , N/A ,$72.25 ,$25.31 ,$23.80 ,$76.50 ,$23.54 ,$11.77 ,$55.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201123,86706,HC HEP B SURFACE AB,302,1 ,$93.00 ,$60.45 ,$10.74 ,$93.00 ,$60.45 ,$10.74 ,$26.04 ,$47.06 ,$10.74 ,$53.48 ,$10.74 ,$47.05 ,$10.74 ,$20.41 ,$76.26 ,$26.85 ,$10.74 ,$79.05 ,$83.70 ,$10.74 ,$69.75 ,$65.10 ,$68.82 ,$68.82 ,$26.85 ,$79.05 ,$10.74 ,$10.74 ,$65.19 ,$10.74 ,$38.69 , N/A ,$79.05 ,$23.09 ,$26.04 ,$83.70 ,$21.48 ,$10.74 ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201125,86709,HC HEP A AB (HAAB) IGM,302,1 ,$192.00 ,$124.80 ,$11.26 ,$192.00 ,$124.80 ,$11.26 ,$53.76 ,$97.15 ,$11.26 ,$110.40 ,$11.26 ,$97.13 ,$11.26 ,$21.39 ,$157.44 ,$28.15 ,$11.26 ,$163.20 ,$172.80 ,$11.26 ,$144.00 ,$134.40 ,$142.08 ,$142.08 ,$28.15 ,$163.20 ,$11.26 ,$11.26 ,$134.59 ,$11.26 ,$79.87 , N/A ,$163.20 ,$24.21 ,$53.76 ,$172.80 ,$22.52 ,$11.26 ,$124.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201127,86762,HC RUBELLA AB,302,1 ,$115.00 ,$74.75 ,$14.39 ,$115.00 ,$74.75 ,$14.39 ,$32.20 ,$58.19 ,$14.39 ,$66.13 ,$14.39 ,$58.18 ,$14.39 ,$27.34 ,$94.30 ,$35.98 ,$14.39 ,$97.75 ,$103.50 ,$14.39 ,$86.25 ,$80.50 ,$85.10 ,$85.10 ,$35.98 ,$97.75 ,$14.39 ,$14.39 ,$80.62 ,$14.39 ,$47.84 , N/A ,$97.75 ,$30.94 ,$32.20 ,$103.50 ,$28.78 ,$14.39 ,$74.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201132,86803,HC HEP C AB,302,1 ,$17.00 ,$11.05 ,$4.76 ,$35.68 ,$11.05 ,$14.27 ,$4.76 ,$8.60 ,$14.27 ,$9.78 ,$14.27 ,$8.60 ,$14.27 ,$17.00 ,$13.94 ,$35.68 ,$14.27 ,$14.45 ,$15.30 ,$14.27 ,$12.75 ,$11.90 ,$12.58 ,$12.58 ,$17.00 ,$14.45 ,$14.27 ,$14.27 ,$11.92 ,$14.27 ,$7.07 , N/A ,$14.45 ,$30.68 ,$4.76 ,$15.30 ,$17.00 ,$14.27 ,$11.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201134,86902,HC RBC AG SCR RGT SERUM T1-90,302,1 ,$100.00 ,$65.00 ,$12.70 ,$717.84 ,$65.00 ,$287.13 ,$28.00 ,$50.60 ,$287.13 ,$57.50 ,$100.00 ,$50.59 ,$100.00 ,$100.00 ,$82.00 ,$717.84 ,$287.13 ,$85.00 ,$90.00 ,$287.13 ,$75.00 ,$70.00 ,$74.00 ,$74.00 ,$100.00 ,$85.00 ,$287.13 ,$287.13 ,$70.10 ,$287.13 ,$41.60 , N/A ,$85.00 ,$617.34 ,$28.00 ,$90.00 ,$12.70 ,$287.13 ,$65.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201135,86902,HC RBC AG SCR RGT SERUM T2-90,302,1 ,$177.00 ,$115.05 ,$12.70 ,$717.84 ,$115.05 ,$287.13 ,$49.56 ,$89.56 ,$287.13 ,$101.78 ,$177.00 ,$89.54 ,$177.00 ,$177.00 ,$145.14 ,$717.84 ,$287.13 ,$150.45 ,$159.30 ,$287.13 ,$132.75 ,$123.90 ,$130.98 ,$130.98 ,$177.00 ,$150.45 ,$287.13 ,$287.13 ,$124.08 ,$287.13 ,$73.63 , N/A ,$150.45 ,$617.34 ,$49.56 ,$159.30 ,$12.70 ,$287.13 ,$115.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201136,86902,HC RBC AG SCR RGT SERUM T3-90,302,1 ,$228.00 ,$148.20 ,$12.70 ,$717.84 ,$148.20 ,$287.13 ,$63.84 ,$115.37 ,$287.13 ,$131.10 ,$228.00 ,$115.35 ,$228.00 ,$228.00 ,$186.96 ,$717.84 ,$287.13 ,$193.80 ,$205.20 ,$287.13 ,$171.00 ,$159.60 ,$168.72 ,$168.72 ,$228.00 ,$193.80 ,$287.13 ,$287.13 ,$159.83 ,$287.13 ,$94.85 , N/A ,$193.80 ,$617.34 ,$63.84 ,$205.20 ,$12.70 ,$287.13 ,$148.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201137,86902,HC RBC AG SCR RGT SERUM T4-90,302,1 ,$281.00 ,$182.65 ,$12.70 ,$717.84 ,$182.65 ,$287.13 ,$78.68 ,$142.19 ,$287.13 ,$161.58 ,$281.00 ,$142.16 ,$281.00 ,$281.00 ,$230.42 ,$717.84 ,$287.13 ,$238.85 ,$252.90 ,$287.13 ,$210.75 ,$196.70 ,$207.94 ,$207.94 ,$281.00 ,$238.85 ,$287.13 ,$287.13 ,$196.98 ,$287.13 ,$116.90 , N/A ,$238.85 ,$617.34 ,$78.68 ,$252.90 ,$12.70 ,$287.13 ,$182.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201138,86905,HC RBC AG TYPING NON ABO/RH T1-90,302,1 ,$124.00 ,$80.60 ,$7.66 ,$717.84 ,$80.60 ,$287.13 ,$34.72 ,$62.74 ,$287.13 ,$71.30 ,$124.00 ,$62.73 ,$124.00 ,$124.00 ,$101.68 ,$717.84 ,$287.13 ,$105.40 ,$111.60 ,$287.13 ,$93.00 ,$86.80 ,$91.76 ,$91.76 ,$124.00 ,$105.40 ,$287.13 ,$287.13 ,$86.92 ,$287.13 ,$51.58 , N/A ,$105.40 ,$617.34 ,$34.72 ,$111.60 ,$7.66 ,$287.13 ,$80.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201139,86905,HC RBC AG TYPING NON ABO/RH T2-90,302,1 ,$155.00 ,$100.75 ,$7.66 ,$717.84 ,$100.75 ,$287.13 ,$43.40 ,$78.43 ,$287.13 ,$89.13 ,$155.00 ,$78.41 ,$155.00 ,$155.00 ,$127.10 ,$717.84 ,$287.13 ,$131.75 ,$139.50 ,$287.13 ,$116.25 ,$108.50 ,$114.70 ,$114.70 ,$155.00 ,$131.75 ,$287.13 ,$287.13 ,$108.66 ,$287.13 ,$64.48 , N/A ,$131.75 ,$617.34 ,$43.40 ,$139.50 ,$7.66 ,$287.13 ,$100.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201140,86905,HC RBC AG TYPING NON ABO/RH T3-90,302,1 ,$264.00 ,$171.60 ,$7.66 ,$717.84 ,$171.60 ,$287.13 ,$73.92 ,$133.58 ,$287.13 ,$151.80 ,$264.00 ,$133.56 ,$264.00 ,$264.00 ,$216.48 ,$717.84 ,$287.13 ,$224.40 ,$237.60 ,$287.13 ,$198.00 ,$184.80 ,$195.36 ,$195.36 ,$264.00 ,$224.40 ,$287.13 ,$287.13 ,$185.06 ,$287.13 ,$109.82 , N/A ,$224.40 ,$617.34 ,$73.92 ,$237.60 ,$7.66 ,$287.13 ,$171.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201141,86905,HC RBC AG TYPING NON ABO/RH T4-90,302,1 ,$281.00 ,$182.65 ,$7.66 ,$717.84 ,$182.65 ,$287.13 ,$78.68 ,$142.19 ,$287.13 ,$161.58 ,$281.00 ,$142.16 ,$281.00 ,$281.00 ,$230.42 ,$717.84 ,$287.13 ,$238.85 ,$252.90 ,$287.13 ,$210.75 ,$196.70 ,$207.94 ,$207.94 ,$281.00 ,$238.85 ,$287.13 ,$287.13 ,$196.98 ,$287.13 ,$116.90 , N/A ,$238.85 ,$617.34 ,$78.68 ,$252.90 ,$7.66 ,$287.13 ,$182.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201148,83986,HC PH BODY FLUID,302,1 ,$24.00 ,$15.60 ,$3.58 ,$24.00 ,$15.60 ,$3.58 ,$6.72 ,$12.14 ,$3.58 ,$13.80 ,$3.58 ,$12.14 ,$3.58 ,$6.80 ,$19.68 ,$8.95 ,$3.58 ,$20.40 ,$21.60 ,$3.58 ,$18.00 ,$16.80 ,$17.76 ,$17.76 ,$8.95 ,$20.40 ,$3.58 ,$3.58 ,$16.82 ,$3.58 ,$9.98 , N/A ,$20.40 ,$7.70 ,$6.72 ,$21.60 ,$7.16 ,$3.58 ,$15.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201189,86015,HC ACTIN SMOOTH MUSC ANTIBODY- 90,302,1 ,$121.00 ,$78.65 ,$11.53 ,$121.00 ,$78.65 ,$11.53 ,$33.88 ,$61.23 ,$11.53 ,$69.58 ,$11.53 ,$61.21 ,$11.53 ,$21.91 ,$99.22 ,$28.83 ,$11.53 ,$102.85 ,$108.90 ,$11.53 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$28.83 ,$102.85 ,$11.53 ,$11.53 ,$84.82 ,$11.53 ,$50.34 , N/A ,$102.85 ,$24.79 ,$33.88 ,$108.90 ,$23.06 ,$11.53 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201190,86036,HC ANTINEUTROPHIL CYTO ANTB SCREEN- 90,302,1 ,$223.00 ,$144.95 ,$12.05 ,$223.00 ,$144.95 ,$12.05 ,$62.44 ,$112.84 ,$12.05 ,$128.23 ,$12.05 ,$112.82 ,$12.05 ,$22.90 ,$182.86 ,$30.13 ,$12.05 ,$189.55 ,$200.70 ,$12.05 ,$167.25 ,$156.10 ,$165.02 ,$165.02 ,$30.13 ,$189.55 ,$12.05 ,$12.05 ,$156.32 ,$12.05 ,$92.77 , N/A ,$189.55 ,$25.91 ,$62.44 ,$200.70 ,$24.10 ,$12.05 ,$144.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201191,86037,HC ANTINEUTROPHIL CYTOPLASMIC ANTIBODY TITER- 90,302,1 ,$56.00 ,$36.40 ,$12.05 ,$56.00 ,$36.40 ,$12.05 ,$15.68 ,$28.34 ,$12.05 ,$32.20 ,$12.05 ,$28.33 ,$12.05 ,$22.90 ,$45.92 ,$30.13 ,$12.05 ,$47.60 ,$50.40 ,$12.05 ,$42.00 ,$39.20 ,$41.44 ,$41.44 ,$30.13 ,$47.60 ,$12.05 ,$12.05 ,$39.26 ,$12.05 ,$23.30 , N/A ,$47.60 ,$25.91 ,$15.68 ,$50.40 ,$24.10 ,$12.05 ,$36.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201192,86364,HC TISS TRANSGLUTAMINASE EA IMMUNO- 90,302,1 ,$121.00 ,$78.65 ,$11.53 ,$121.00 ,$78.65 ,$11.53 ,$33.88 ,$61.23 ,$11.53 ,$69.58 ,$11.53 ,$61.21 ,$11.53 ,$21.91 ,$99.22 ,$28.83 ,$11.53 ,$102.85 ,$108.90 ,$11.53 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$28.83 ,$102.85 ,$11.53 ,$11.53 ,$84.82 ,$11.53 ,$50.34 , N/A ,$102.85 ,$24.79 ,$33.88 ,$108.90 ,$23.06 ,$11.53 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201193,86231,HC EMA EACH IG CLASS- 90,302,1 ,$184.00 ,$119.60 ,$12.09 ,$184.00 ,$119.60 ,$12.09 ,$51.52 ,$93.10 ,$12.09 ,$105.80 ,$12.09 ,$93.09 ,$12.09 ,$22.97 ,$150.88 ,$30.23 ,$12.09 ,$156.40 ,$165.60 ,$12.09 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$30.23 ,$156.40 ,$12.09 ,$12.09 ,$128.98 ,$12.09 ,$76.54 , N/A ,$156.40 ,$25.99 ,$51.52 ,$165.60 ,$24.18 ,$12.09 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201194,86258,HC GLIADIN ANTIBODY EA- 90,302,1 ,$121.00 ,$78.65 ,$11.53 ,$121.00 ,$78.65 ,$11.53 ,$33.88 ,$61.23 ,$11.53 ,$69.58 ,$11.53 ,$61.21 ,$11.53 ,$21.91 ,$99.22 ,$28.83 ,$11.53 ,$102.85 ,$108.90 ,$11.53 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$28.83 ,$102.85 ,$11.53 ,$11.53 ,$84.82 ,$11.53 ,$50.34 , N/A ,$102.85 ,$24.79 ,$33.88 ,$108.90 ,$23.06 ,$11.53 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30201195,86381,HC MITOCHONDRIAL ANTIBODY- 90,302,1 ,$184.00 ,$119.60 ,$25.45 ,$184.00 ,$119.60 ,$25.45 ,$51.52 ,$93.10 ,$25.45 ,$105.80 ,$25.45 ,$93.09 ,$25.45 ,$48.36 ,$150.88 ,$63.63 ,$25.45 ,$156.40 ,$165.60 ,$25.45 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$63.63 ,$156.40 ,$25.45 ,$25.45 ,$128.98 ,$25.45 ,$76.54 , N/A ,$156.40 ,$54.72 ,$51.52 ,$165.60 ,$50.90 ,$25.45 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$60.00 ,$39.00 ,$3.80 ,$60.00 ,$39.00 ,$3.80 ,$16.80 ,$30.36 ,$3.80 ,$34.50 ,$3.80 ,$30.35 ,$3.80 ,$7.22 ,$49.20 ,$9.50 ,$3.80 ,$51.00 ,$54.00 ,$3.80 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$9.50 ,$51.00 ,$3.80 ,$3.80 ,$42.06 ,$3.80 ,$24.96 , N/A ,$51.00 ,$8.17 ,$16.80 ,$54.00 ,$7.60 ,$3.80 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500104,85014,HC HEMATOCRIT,305,1 ,$45.00 ,$29.25 ,$2.37 ,$45.00 ,$29.25 ,$2.37 ,$12.60 ,$22.77 ,$2.37 ,$25.88 ,$2.37 ,$22.77 ,$2.37 ,$4.50 ,$36.90 ,$5.93 ,$2.37 ,$38.25 ,$40.50 ,$2.37 ,$33.75 ,$31.50 ,$33.30 ,$33.30 ,$5.93 ,$38.25 ,$2.37 ,$2.37 ,$31.55 ,$2.37 ,$18.72 , N/A ,$38.25 ,$5.10 ,$12.60 ,$40.50 ,$4.74 ,$2.37 ,$29.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500106,85018,HC HGB,305,1 ,$45.00 ,$29.25 ,$2.37 ,$45.00 ,$29.25 ,$2.37 ,$12.60 ,$22.77 ,$2.37 ,$25.88 ,$2.37 ,$22.77 ,$2.37 ,$4.50 ,$36.90 ,$5.93 ,$2.37 ,$38.25 ,$40.50 ,$2.37 ,$33.75 ,$31.50 ,$33.30 ,$33.30 ,$5.93 ,$38.25 ,$2.37 ,$2.37 ,$31.55 ,$2.37 ,$18.72 , N/A ,$38.25 ,$5.10 ,$12.60 ,$40.50 ,$4.74 ,$2.37 ,$29.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$131.00 ,$85.15 ,$7.77 ,$131.00 ,$85.15 ,$7.77 ,$36.68 ,$66.29 ,$7.77 ,$75.33 ,$7.77 ,$66.27 ,$7.77 ,$14.76 ,$107.42 ,$19.43 ,$7.77 ,$111.35 ,$117.90 ,$7.77 ,$98.25 ,$91.70 ,$96.94 ,$96.94 ,$19.43 ,$111.35 ,$7.77 ,$7.77 ,$91.83 ,$7.77 ,$54.50 , N/A ,$111.35 ,$16.71 ,$36.68 ,$117.90 ,$15.54 ,$7.77 ,$85.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500108,85027,HC CBC W/O DIFF,305,1 ,$99.00 ,$64.35 ,$6.47 ,$99.00 ,$64.35 ,$6.47 ,$27.72 ,$50.09 ,$6.47 ,$56.93 ,$6.47 ,$50.08 ,$6.47 ,$12.29 ,$81.18 ,$16.18 ,$6.47 ,$84.15 ,$89.10 ,$6.47 ,$74.25 ,$69.30 ,$73.26 ,$73.26 ,$16.18 ,$84.15 ,$6.47 ,$6.47 ,$69.40 ,$6.47 ,$41.18 , N/A ,$84.15 ,$13.91 ,$27.72 ,$89.10 ,$12.94 ,$6.47 ,$64.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$77.00 ,$50.05 ,$2.54 ,$77.00 ,$50.05 ,$2.54 ,$21.56 ,$38.96 ,$2.54 ,$44.28 ,$2.54 ,$38.95 ,$2.54 ,$4.83 ,$63.14 ,$6.35 ,$2.54 ,$65.45 ,$69.30 ,$2.54 ,$57.75 ,$53.90 ,$56.98 ,$56.98 ,$6.35 ,$65.45 ,$2.54 ,$2.54 ,$53.98 ,$2.54 ,$32.03 , N/A ,$65.45 ,$5.46 ,$21.56 ,$69.30 ,$5.08 ,$2.54 ,$50.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$59.00 ,$38.35 ,$4.48 ,$59.00 ,$38.35 ,$4.48 ,$16.52 ,$29.85 ,$4.48 ,$33.93 ,$4.48 ,$29.85 ,$4.48 ,$8.51 ,$48.38 ,$11.20 ,$4.48 ,$50.15 ,$53.10 ,$4.48 ,$44.25 ,$41.30 ,$43.66 ,$43.66 ,$11.20 ,$50.15 ,$4.48 ,$4.48 ,$41.36 ,$4.48 ,$24.54 , N/A ,$50.15 ,$9.63 ,$16.52 ,$53.10 ,$8.96 ,$4.48 ,$38.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500175,85379,HC D DIMER QN,305,1 ,$210.00 ,$136.50 ,$10.18 ,$210.00 ,$136.50 ,$10.18 ,$58.80 ,$106.26 ,$10.18 ,$120.75 ,$10.18 ,$106.24 ,$10.18 ,$19.34 ,$172.20 ,$25.45 ,$10.18 ,$178.50 ,$189.00 ,$10.18 ,$157.50 ,$147.00 ,$155.40 ,$155.40 ,$25.45 ,$178.50 ,$10.18 ,$10.18 ,$147.21 ,$10.18 ,$87.36 , N/A ,$178.50 ,$21.89 ,$58.80 ,$189.00 ,$20.36 ,$10.18 ,$136.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$87.00 ,$56.55 ,$4.29 ,$87.00 ,$56.55 ,$4.29 ,$24.36 ,$44.02 ,$4.29 ,$50.03 ,$4.29 ,$44.01 ,$4.29 ,$8.15 ,$71.34 ,$10.73 ,$4.29 ,$73.95 ,$78.30 ,$4.29 ,$65.25 ,$60.90 ,$64.38 ,$64.38 ,$10.73 ,$73.95 ,$4.29 ,$4.29 ,$60.99 ,$4.29 ,$36.19 , N/A ,$73.95 ,$9.22 ,$24.36 ,$78.30 ,$8.58 ,$4.29 ,$56.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500205,85652,HC SED RATE AUTO,305,1 ,$77.00 ,$50.05 ,$2.70 ,$77.00 ,$50.05 ,$2.70 ,$21.56 ,$38.96 ,$2.70 ,$44.28 ,$2.70 ,$38.95 ,$2.70 ,$5.13 ,$63.14 ,$6.75 ,$2.70 ,$65.45 ,$69.30 ,$2.70 ,$57.75 ,$53.90 ,$56.98 ,$56.98 ,$6.75 ,$65.45 ,$2.70 ,$2.70 ,$53.98 ,$2.70 ,$32.03 , N/A ,$65.45 ,$5.81 ,$21.56 ,$69.30 ,$5.40 ,$2.70 ,$50.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500211,85730,HC PTT,305,1 ,$142.00 ,$92.30 ,$6.01 ,$142.00 ,$92.30 ,$6.01 ,$39.76 ,$71.85 ,$6.01 ,$81.65 ,$6.01 ,$71.84 ,$6.01 ,$11.42 ,$116.44 ,$15.03 ,$6.01 ,$120.70 ,$127.80 ,$6.01 ,$106.50 ,$99.40 ,$105.08 ,$105.08 ,$15.03 ,$120.70 ,$6.01 ,$6.01 ,$99.54 ,$6.01 ,$59.07 , N/A ,$120.70 ,$12.92 ,$39.76 ,$127.80 ,$12.02 ,$6.01 ,$92.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500234,85014,HC HEMATOCRIT-90,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$24.70 ,$2.37 ,$10.64 ,$19.23 ,$2.37 ,$21.85 ,$2.37 ,$19.22 ,$2.37 ,$4.50 ,$31.16 ,$5.93 ,$2.37 ,$32.30 ,$34.20 ,$2.37 ,$28.50 ,$26.60 ,$28.12 ,$28.12 ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$26.64 ,$2.37 ,$15.81 , N/A ,$32.30 ,$5.10 ,$10.64 ,$34.20 ,$4.74 ,$2.37 ,$24.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500238,85018,HC HGB-90,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$24.70 ,$2.37 ,$10.64 ,$19.23 ,$2.37 ,$21.85 ,$2.37 ,$19.22 ,$2.37 ,$4.50 ,$31.16 ,$5.93 ,$2.37 ,$32.30 ,$34.20 ,$2.37 ,$28.50 ,$26.60 ,$28.12 ,$28.12 ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$26.64 ,$2.37 ,$15.81 , N/A ,$32.30 ,$5.10 ,$10.64 ,$34.20 ,$4.74 ,$2.37 ,$24.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500244,85041,HC BLOOD COUNT RBC AUTO-90,305,1 ,$29.00 ,$18.85 ,$3.02 ,$29.00 ,$18.85 ,$3.02 ,$8.12 ,$14.67 ,$3.02 ,$16.68 ,$3.02 ,$14.67 ,$3.02 ,$5.74 ,$23.78 ,$7.55 ,$3.02 ,$24.65 ,$26.10 ,$3.02 ,$21.75 ,$20.30 ,$21.46 ,$21.46 ,$7.55 ,$24.65 ,$3.02 ,$3.02 ,$20.33 ,$3.02 ,$12.06 , N/A ,$24.65 ,$6.49 ,$8.12 ,$26.10 ,$6.04 ,$3.02 ,$18.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500249,85210,HC FACTOR II-90,305,1 ,$247.00 ,$160.55 ,$12.98 ,$247.00 ,$160.55 ,$12.98 ,$69.16 ,$124.98 ,$12.98 ,$142.03 ,$12.98 ,$124.96 ,$12.98 ,$24.66 ,$202.54 ,$32.45 ,$12.98 ,$209.95 ,$222.30 ,$12.98 ,$185.25 ,$172.90 ,$182.78 ,$182.78 ,$32.45 ,$209.95 ,$12.98 ,$12.98 ,$173.15 ,$12.98 ,$102.75 , N/A ,$209.95 ,$27.91 ,$69.16 ,$222.30 ,$25.96 ,$12.98 ,$160.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500250,85220,HC FACTOR V-90,305,1 ,$151.00 ,$98.15 ,$17.65 ,$151.00 ,$98.15 ,$17.65 ,$42.28 ,$76.41 ,$17.65 ,$86.83 ,$17.65 ,$76.39 ,$17.65 ,$33.54 ,$123.82 ,$44.13 ,$17.65 ,$128.35 ,$135.90 ,$17.65 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$44.13 ,$128.35 ,$17.65 ,$17.65 ,$105.85 ,$17.65 ,$62.82 , N/A ,$128.35 ,$37.95 ,$42.28 ,$135.90 ,$35.30 ,$17.65 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500251,85230,HC FACTOR VII-90,305,1 ,$145.00 ,$94.25 ,$17.90 ,$145.00 ,$94.25 ,$17.90 ,$40.60 ,$73.37 ,$17.90 ,$83.38 ,$17.90 ,$73.36 ,$17.90 ,$34.01 ,$118.90 ,$44.75 ,$17.90 ,$123.25 ,$130.50 ,$17.90 ,$108.75 ,$101.50 ,$107.30 ,$107.30 ,$44.75 ,$123.25 ,$17.90 ,$17.90 ,$101.65 ,$17.90 ,$60.32 , N/A ,$123.25 ,$38.49 ,$40.60 ,$130.50 ,$35.80 ,$17.90 ,$94.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500252,85240,HC FACTOR VIII AHG-90,305,1 ,$167.00 ,$108.55 ,$17.90 ,$167.00 ,$108.55 ,$17.90 ,$46.76 ,$84.50 ,$17.90 ,$96.03 ,$17.90 ,$84.49 ,$17.90 ,$34.01 ,$136.94 ,$44.75 ,$17.90 ,$141.95 ,$150.30 ,$17.90 ,$125.25 ,$116.90 ,$123.58 ,$123.58 ,$44.75 ,$141.95 ,$17.90 ,$17.90 ,$117.07 ,$17.90 ,$69.47 , N/A ,$141.95 ,$38.49 ,$46.76 ,$150.30 ,$35.80 ,$17.90 ,$108.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500253,85245,HC FACTOR VIII VW RISTO-90,305,1 ,$81.00 ,$52.65 ,$22.68 ,$81.00 ,$52.65 ,$22.94 ,$22.68 ,$40.99 ,$22.94 ,$46.58 ,$22.94 ,$40.98 ,$22.94 ,$43.59 ,$66.42 ,$57.35 ,$22.94 ,$68.85 ,$72.90 ,$22.94 ,$60.75 ,$56.70 ,$59.94 ,$59.94 ,$57.35 ,$68.85 ,$22.94 ,$22.94 ,$56.78 ,$22.94 ,$33.70 , N/A ,$68.85 ,$49.32 ,$22.68 ,$72.90 ,$45.88 ,$22.94 ,$52.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500254,85246,HC FACTOR VIII VW AG-90,305,1 ,$389.00 ,$252.85 ,$22.94 ,$389.00 ,$252.85 ,$22.94 ,$108.92 ,$196.83 ,$22.94 ,$223.68 ,$22.94 ,$196.80 ,$22.94 ,$43.59 ,$318.98 ,$57.35 ,$22.94 ,$330.65 ,$350.10 ,$22.94 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$57.35 ,$330.65 ,$22.94 ,$22.94 ,$272.69 ,$22.94 ,$161.82 , N/A ,$330.65 ,$49.32 ,$108.92 ,$350.10 ,$45.88 ,$22.94 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500255,85247,HC FACTOR VW MULTIM ANALY-90,305,1 ,$122.00 ,$79.30 ,$22.94 ,$122.00 ,$79.30 ,$22.94 ,$34.16 ,$61.73 ,$22.94 ,$70.15 ,$22.94 ,$61.72 ,$22.94 ,$43.59 ,$100.04 ,$57.35 ,$22.94 ,$103.70 ,$109.80 ,$22.94 ,$91.50 ,$85.40 ,$90.28 ,$90.28 ,$57.35 ,$103.70 ,$22.94 ,$22.94 ,$85.52 ,$22.94 ,$50.75 , N/A ,$103.70 ,$49.32 ,$34.16 ,$109.80 ,$45.88 ,$22.94 ,$79.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500256,85250,HC FACTOR IX-90,305,1 ,$133.00 ,$86.45 ,$19.04 ,$133.00 ,$86.45 ,$19.04 ,$37.24 ,$67.30 ,$19.04 ,$76.48 ,$19.04 ,$67.28 ,$19.04 ,$36.18 ,$109.06 ,$47.60 ,$19.04 ,$113.05 ,$119.70 ,$19.04 ,$99.75 ,$93.10 ,$98.42 ,$98.42 ,$47.60 ,$113.05 ,$19.04 ,$19.04 ,$93.23 ,$19.04 ,$55.33 , N/A ,$113.05 ,$40.94 ,$37.24 ,$119.70 ,$38.08 ,$19.04 ,$86.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500257,85260,HC FACTOR X-90,305,1 ,$151.00 ,$98.15 ,$17.90 ,$151.00 ,$98.15 ,$17.90 ,$42.28 ,$76.41 ,$17.90 ,$86.83 ,$17.90 ,$76.39 ,$17.90 ,$34.01 ,$123.82 ,$44.75 ,$17.90 ,$128.35 ,$135.90 ,$17.90 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$44.75 ,$128.35 ,$17.90 ,$17.90 ,$105.85 ,$17.90 ,$62.82 , N/A ,$128.35 ,$38.49 ,$42.28 ,$135.90 ,$35.80 ,$17.90 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500258,85270,HC FACTOR XI-90,305,1 ,$52.06 ,$33.84 ,$14.58 ,$52.06 ,$33.84 ,$17.90 ,$14.58 ,$26.34 ,$17.90 ,$29.93 ,$17.90 ,$26.34 ,$17.90 ,$34.01 ,$42.69 ,$44.75 ,$17.90 ,$44.25 ,$46.85 ,$17.90 ,$39.05 ,$36.44 ,$38.52 ,$38.52 ,$44.75 ,$44.25 ,$17.90 ,$17.90 ,$36.49 ,$17.90 ,$21.66 , N/A ,$44.25 ,$38.49 ,$14.58 ,$46.85 ,$35.80 ,$17.90 ,$33.84 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500259,85280,HC FACTOR XI-90,305,1 ,$52.06 ,$33.84 ,$14.58 ,$52.06 ,$33.84 ,$19.35 ,$14.58 ,$26.34 ,$19.35 ,$29.93 ,$19.35 ,$26.34 ,$19.35 ,$36.77 ,$42.69 ,$48.38 ,$19.35 ,$44.25 ,$46.85 ,$19.35 ,$39.05 ,$36.44 ,$38.52 ,$38.52 ,$48.38 ,$44.25 ,$19.35 ,$19.35 ,$36.49 ,$19.35 ,$21.66 , N/A ,$44.25 ,$41.60 ,$14.58 ,$46.85 ,$38.70 ,$19.35 ,$33.84 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500261,85300,HC ANTITHROMBIN III ACT-90,305,1 ,$177.00 ,$115.05 ,$11.85 ,$177.00 ,$115.05 ,$11.85 ,$49.56 ,$89.56 ,$11.85 ,$101.78 ,$11.85 ,$89.54 ,$11.85 ,$22.52 ,$145.14 ,$29.63 ,$11.85 ,$150.45 ,$159.30 ,$11.85 ,$132.75 ,$123.90 ,$130.98 ,$130.98 ,$29.63 ,$150.45 ,$11.85 ,$11.85 ,$124.08 ,$11.85 ,$73.63 , N/A ,$150.45 ,$25.48 ,$49.56 ,$159.30 ,$23.70 ,$11.85 ,$115.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500262,85301,HC ANTITHROMBIN III AG-90,305,1 ,$310.00 ,$201.50 ,$10.81 ,$310.00 ,$201.50 ,$10.81 ,$86.80 ,$156.86 ,$10.81 ,$178.25 ,$10.81 ,$156.83 ,$10.81 ,$20.54 ,$254.20 ,$27.03 ,$10.81 ,$263.50 ,$279.00 ,$10.81 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$27.03 ,$263.50 ,$10.81 ,$10.81 ,$217.31 ,$10.81 ,$128.96 , N/A ,$263.50 ,$23.24 ,$86.80 ,$279.00 ,$21.62 ,$10.81 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500263,85302,HC PROTEIN C AG-90,305,1 ,$331.00 ,$215.15 ,$12.01 ,$331.00 ,$215.15 ,$12.01 ,$92.68 ,$167.49 ,$12.01 ,$190.33 ,$12.01 ,$167.45 ,$12.01 ,$22.82 ,$271.42 ,$30.03 ,$12.01 ,$281.35 ,$297.90 ,$12.01 ,$248.25 ,$231.70 ,$244.94 ,$244.94 ,$30.03 ,$281.35 ,$12.01 ,$12.01 ,$232.03 ,$12.01 ,$137.70 , N/A ,$281.35 ,$25.82 ,$92.68 ,$297.90 ,$24.02 ,$12.01 ,$215.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500264,85303,HC PROTEIN C ACTIVITY-90,305,1 ,$215.00 ,$139.75 ,$13.84 ,$215.00 ,$139.75 ,$13.84 ,$60.20 ,$108.79 ,$13.84 ,$123.63 ,$13.84 ,$108.77 ,$13.84 ,$26.30 ,$176.30 ,$34.60 ,$13.84 ,$182.75 ,$193.50 ,$13.84 ,$161.25 ,$150.50 ,$159.10 ,$159.10 ,$34.60 ,$182.75 ,$13.84 ,$13.84 ,$150.72 ,$13.84 ,$89.44 , N/A ,$182.75 ,$29.76 ,$60.20 ,$193.50 ,$27.68 ,$13.84 ,$139.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500265,85305,HC PROTEIN S TOTAL-90,305,1 ,$419.00 ,$272.35 ,$11.61 ,$419.00 ,$272.35 ,$11.61 ,$117.32 ,$212.01 ,$11.61 ,$240.93 ,$11.61 ,$211.97 ,$11.61 ,$22.06 ,$343.58 ,$29.03 ,$11.61 ,$356.15 ,$377.10 ,$11.61 ,$314.25 ,$293.30 ,$310.06 ,$310.06 ,$29.03 ,$356.15 ,$11.61 ,$11.61 ,$293.72 ,$11.61 ,$174.30 , N/A ,$356.15 ,$24.96 ,$117.32 ,$377.10 ,$23.22 ,$11.61 ,$272.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500266,85306,HC PROTEIN S FREE-90,305,1 ,$201.00 ,$130.65 ,$15.32 ,$201.00 ,$130.65 ,$15.32 ,$56.28 ,$101.71 ,$15.32 ,$115.58 ,$15.32 ,$101.69 ,$15.32 ,$29.11 ,$164.82 ,$38.30 ,$15.32 ,$170.85 ,$180.90 ,$15.32 ,$150.75 ,$140.70 ,$148.74 ,$148.74 ,$38.30 ,$170.85 ,$15.32 ,$15.32 ,$140.90 ,$15.32 ,$83.62 , N/A ,$170.85 ,$32.94 ,$56.28 ,$180.90 ,$30.64 ,$15.32 ,$130.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500267,85307,HC ACTIVATED PROTEIN C RESIST-90,305,1 ,$139.00 ,$90.35 ,$15.32 ,$139.00 ,$90.35 ,$15.32 ,$38.92 ,$70.33 ,$15.32 ,$79.93 ,$15.32 ,$70.32 ,$15.32 ,$29.11 ,$113.98 ,$38.30 ,$15.32 ,$118.15 ,$125.10 ,$15.32 ,$104.25 ,$97.30 ,$102.86 ,$102.86 ,$38.30 ,$118.15 ,$15.32 ,$15.32 ,$97.44 ,$15.32 ,$57.82 , N/A ,$118.15 ,$32.94 ,$38.92 ,$125.10 ,$30.64 ,$15.32 ,$90.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500277,85415,HC PLASMINGEN ACTIVATOR INHIB-90,305,1 ,$216.00 ,$140.40 ,$17.19 ,$216.00 ,$140.40 ,$17.19 ,$60.48 ,$109.30 ,$17.19 ,$124.20 ,$17.19 ,$109.27 ,$17.19 ,$32.66 ,$177.12 ,$42.98 ,$17.19 ,$183.60 ,$194.40 ,$17.19 ,$162.00 ,$151.20 ,$159.84 ,$159.84 ,$42.98 ,$183.60 ,$17.19 ,$17.19 ,$151.42 ,$17.19 ,$89.86 , N/A ,$183.60 ,$36.96 ,$60.48 ,$194.40 ,$34.38 ,$17.19 ,$140.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500287,85549,HC MURAMIDASE-90,305,1 ,$70.00 ,$45.50 ,$18.75 ,$70.00 ,$45.50 ,$18.75 ,$19.60 ,$35.42 ,$18.75 ,$40.25 ,$18.75 ,$35.41 ,$18.75 ,$35.63 ,$57.40 ,$46.88 ,$18.75 ,$59.50 ,$63.00 ,$18.75 ,$52.50 ,$49.00 ,$51.80 ,$51.80 ,$46.88 ,$59.50 ,$18.75 ,$18.75 ,$49.07 ,$18.75 ,$29.12 , N/A ,$59.50 ,$40.31 ,$19.60 ,$63.00 ,$37.50 ,$18.75 ,$45.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500289,85597,HC PLATELET NEUTRALIZATION-90,305,1 ,$40.00 ,$26.00 ,$11.20 ,$44.95 ,$26.00 ,$17.98 ,$11.20 ,$20.24 ,$17.98 ,$23.00 ,$17.98 ,$20.24 ,$17.98 ,$34.16 ,$32.80 ,$44.95 ,$17.98 ,$34.00 ,$36.00 ,$17.98 ,$30.00 ,$28.00 ,$29.60 ,$29.60 ,$40.00 ,$34.00 ,$17.98 ,$17.98 ,$28.04 ,$17.98 ,$16.64 , N/A ,$34.00 ,$38.66 ,$11.20 ,$36.00 ,$35.96 ,$17.98 ,$26.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500297,85613,HC RUSSELL VIPER VENOM SCR T1-90,305,1 ,$66.00 ,$42.90 ,$9.58 ,$66.00 ,$42.90 ,$9.58 ,$18.48 ,$33.40 ,$9.58 ,$37.95 ,$9.58 ,$33.39 ,$9.58 ,$18.20 ,$54.12 ,$23.95 ,$9.58 ,$56.10 ,$59.40 ,$9.58 ,$49.50 ,$46.20 ,$48.84 ,$48.84 ,$23.95 ,$56.10 ,$9.58 ,$9.58 ,$46.27 ,$9.58 ,$27.46 , N/A ,$56.10 ,$20.60 ,$18.48 ,$59.40 ,$19.16 ,$9.58 ,$42.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500304,85670,HC THROMBIN TIME PLASMA-90,305,1 ,$54.00 ,$35.10 ,$5.77 ,$54.00 ,$35.10 ,$5.77 ,$15.12 ,$27.32 ,$5.77 ,$31.05 ,$5.77 ,$27.32 ,$5.77 ,$10.96 ,$44.28 ,$14.43 ,$5.77 ,$45.90 ,$48.60 ,$5.77 ,$40.50 ,$37.80 ,$39.96 ,$39.96 ,$14.43 ,$45.90 ,$5.77 ,$5.77 ,$37.85 ,$5.77 ,$22.46 , N/A ,$45.90 ,$12.41 ,$15.12 ,$48.60 ,$11.54 ,$5.77 ,$35.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500305,85730,HC PTT-90,305,1 ,$105.00 ,$68.25 ,$6.01 ,$105.00 ,$68.25 ,$6.01 ,$29.40 ,$53.13 ,$6.01 ,$60.38 ,$6.01 ,$53.12 ,$6.01 ,$11.42 ,$86.10 ,$15.03 ,$6.01 ,$89.25 ,$94.50 ,$6.01 ,$78.75 ,$73.50 ,$77.70 ,$77.70 ,$15.03 ,$89.25 ,$6.01 ,$6.01 ,$73.61 ,$6.01 ,$43.68 , N/A ,$89.25 ,$12.92 ,$29.40 ,$94.50 ,$12.02 ,$6.01 ,$68.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500310,85810,HC VISCOSITY-90,305,1 ,$128.00 ,$83.20 ,$11.67 ,$128.00 ,$83.20 ,$11.67 ,$35.84 ,$64.77 ,$11.67 ,$73.60 ,$11.67 ,$64.76 ,$11.67 ,$22.17 ,$104.96 ,$29.18 ,$11.67 ,$108.80 ,$115.20 ,$11.67 ,$96.00 ,$89.60 ,$94.72 ,$94.72 ,$29.18 ,$108.80 ,$11.67 ,$11.67 ,$89.73 ,$11.67 ,$53.25 , N/A ,$108.80 ,$25.09 ,$35.84 ,$115.20 ,$23.34 ,$11.67 ,$83.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500341,85046,HC BLOOD COUNT RETICULOCYTES AUTO,305,1 ,$149.00 ,$96.85 ,$5.57 ,$149.00 ,$96.85 ,$5.57 ,$41.72 ,$75.39 ,$5.57 ,$85.68 ,$5.57 ,$75.38 ,$5.57 ,$10.58 ,$122.18 ,$13.93 ,$5.57 ,$126.65 ,$134.10 ,$5.57 ,$111.75 ,$104.30 ,$110.26 ,$110.26 ,$13.93 ,$126.65 ,$5.57 ,$5.57 ,$104.45 ,$5.57 ,$61.98 , N/A ,$126.65 ,$11.98 ,$41.72 ,$134.10 ,$11.14 ,$5.57 ,$96.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500831,85384,HC FIBRINOGEN,305,1 ,$158.00 ,$102.70 ,$9.72 ,$158.00 ,$102.70 ,$9.72 ,$44.24 ,$79.95 ,$9.72 ,$90.85 ,$9.72 ,$79.93 ,$9.72 ,$18.47 ,$129.56 ,$24.30 ,$9.72 ,$134.30 ,$142.20 ,$9.72 ,$118.50 ,$110.60 ,$116.92 ,$116.92 ,$24.30 ,$134.30 ,$9.72 ,$9.72 ,$110.76 ,$9.72 ,$65.73 , N/A ,$134.30 ,$20.90 ,$44.24 ,$142.20 ,$19.44 ,$9.72 ,$102.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30500833,85520,HC HEPARIN ASSAY,305,1 ,$548.00 ,$356.20 ,$13.09 ,$548.00 ,$356.20 ,$13.09 ,$153.44 ,$277.29 ,$13.09 ,$315.10 ,$13.09 ,$277.23 ,$13.09 ,$24.87 ,$449.36 ,$32.73 ,$13.09 ,$465.80 ,$493.20 ,$13.09 ,$411.00 ,$383.60 ,$405.52 ,$405.52 ,$32.73 ,$465.80 ,$13.09 ,$13.09 ,$384.15 ,$13.09 ,$227.97 , N/A ,$465.80 ,$28.14 ,$153.44 ,$493.20 ,$26.18 ,$13.09 ,$356.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600096,87480,HC CANDIDA SPECIES DNA SCREEN,306,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 ,$39.00 ,$20.05 ,$16.80 ,$30.36 ,$20.05 ,$34.50 ,$20.05 ,$30.35 ,$20.05 ,$38.10 ,$49.20 ,$50.13 ,$20.05 ,$51.00 ,$54.00 ,$20.05 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$50.13 ,$51.00 ,$20.05 ,$20.05 ,$42.06 ,$20.05 ,$24.96 , N/A ,$51.00 ,$43.11 ,$16.80 ,$54.00 ,$40.10 ,$20.05 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600097,87660,HC TRICHOMONAS DNA SCREEN,306,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 ,$39.00 ,$20.05 ,$16.80 ,$30.36 ,$20.05 ,$34.50 ,$20.05 ,$30.35 ,$20.05 ,$38.10 ,$49.20 ,$50.13 ,$20.05 ,$51.00 ,$54.00 ,$20.05 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$50.13 ,$51.00 ,$20.05 ,$20.05 ,$42.06 ,$20.05 ,$24.96 , N/A ,$51.00 ,$43.11 ,$16.80 ,$54.00 ,$40.10 ,$20.05 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600098,87510,HC G VAGINALIS DNA SCREEN,306,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 ,$39.00 ,$20.05 ,$16.80 ,$30.36 ,$20.05 ,$34.50 ,$20.05 ,$30.35 ,$20.05 ,$38.10 ,$49.20 ,$50.13 ,$20.05 ,$51.00 ,$54.00 ,$20.05 ,$45.00 ,$42.00 ,$44.40 ,$44.40 ,$50.13 ,$51.00 ,$20.05 ,$20.05 ,$42.06 ,$20.05 ,$24.96 , N/A ,$51.00 ,$43.11 ,$16.80 ,$54.00 ,$40.10 ,$20.05 ,$39.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 ,$23.40 ,$11.98 ,$10.08 ,$18.22 ,$11.98 ,$20.70 ,$11.98 ,$18.21 ,$11.98 ,$22.76 ,$29.52 ,$29.95 ,$11.98 ,$30.60 ,$32.40 ,$11.98 ,$27.00 ,$25.20 ,$26.64 ,$26.64 ,$29.95 ,$30.60 ,$11.98 ,$11.98 ,$25.24 ,$11.98 ,$14.98 , N/A ,$30.60 ,$25.76 ,$10.08 ,$32.40 ,$23.96 ,$11.98 ,$23.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600225,87400,HC EIA QL INFLUENZA A/B AG,306,1 ,$146.00 ,$94.90 ,$14.13 ,$146.00 ,$94.90 ,$14.13 ,$40.88 ,$73.88 ,$14.13 ,$83.95 ,$14.13 ,$73.86 ,$14.13 ,$26.85 ,$119.72 ,$35.33 ,$14.13 ,$124.10 ,$131.40 ,$14.13 ,$109.50 ,$102.20 ,$108.04 ,$108.04 ,$35.33 ,$124.10 ,$14.13 ,$14.13 ,$102.35 ,$14.13 ,$60.74 , N/A ,$124.10 ,$30.38 ,$40.88 ,$131.40 ,$28.26 ,$14.13 ,$94.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600226,87420,HC RSV AG QL,306,1 ,$170.00 ,$110.50 ,$13.91 ,$170.00 ,$110.50 ,$13.91 ,$47.60 ,$86.02 ,$13.91 ,$97.75 ,$13.91 ,$86.00 ,$13.91 ,$26.43 ,$139.40 ,$34.78 ,$13.91 ,$144.50 ,$153.00 ,$13.91 ,$127.50 ,$119.00 ,$125.80 ,$125.80 ,$34.78 ,$144.50 ,$13.91 ,$13.91 ,$119.17 ,$13.91 ,$70.72 , N/A ,$144.50 ,$29.91 ,$47.60 ,$153.00 ,$27.82 ,$13.91 ,$110.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600318,87449,HC EIA QL MLT AG INF,306,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 ,$23.40 ,$11.98 ,$10.08 ,$18.22 ,$11.98 ,$20.70 ,$11.98 ,$18.21 ,$11.98 ,$22.76 ,$29.52 ,$29.95 ,$11.98 ,$30.60 ,$32.40 ,$11.98 ,$27.00 ,$25.20 ,$26.64 ,$26.64 ,$29.95 ,$30.60 ,$11.98 ,$11.98 ,$25.24 ,$11.98 ,$14.98 , N/A ,$30.60 ,$25.76 ,$10.08 ,$32.40 ,$23.96 ,$11.98 ,$23.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600353,87015,HC CONCENTRATION INFECTIOUS AGENT-90,306,1 ,$70.00 ,$45.50 ,$6.68 ,$70.00 ,$45.50 ,$6.68 ,$19.60 ,$35.42 ,$6.68 ,$40.25 ,$6.68 ,$35.41 ,$6.68 ,$12.69 ,$57.40 ,$16.70 ,$6.68 ,$59.50 ,$63.00 ,$6.68 ,$52.50 ,$49.00 ,$51.80 ,$51.80 ,$16.70 ,$59.50 ,$6.68 ,$6.68 ,$49.07 ,$6.68 ,$29.12 , N/A ,$59.50 ,$14.36 ,$19.60 ,$63.00 ,$13.36 ,$6.68 ,$45.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600360,87081,HC CULTURE SCR PRESUMP PATHOGENS T1,306,1 ,$153.00 ,$99.45 ,$6.63 ,$153.00 ,$99.45 ,$6.63 ,$42.84 ,$77.42 ,$6.63 ,$87.98 ,$6.63 ,$77.40 ,$6.63 ,$12.60 ,$125.46 ,$16.58 ,$6.63 ,$130.05 ,$137.70 ,$6.63 ,$114.75 ,$107.10 ,$113.22 ,$113.22 ,$16.58 ,$130.05 ,$6.63 ,$6.63 ,$107.25 ,$6.63 ,$63.65 , N/A ,$130.05 ,$14.25 ,$42.84 ,$137.70 ,$13.26 ,$6.63 ,$99.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600363,87103,HC CULTURE FUNGUS BLOOD-90,306,1 ,$188.00 ,$122.20 ,$20.46 ,$188.00 ,$122.20 ,$20.46 ,$52.64 ,$95.13 ,$20.46 ,$108.10 ,$20.46 ,$95.11 ,$20.46 ,$38.87 ,$154.16 ,$51.15 ,$20.46 ,$159.80 ,$169.20 ,$20.46 ,$141.00 ,$131.60 ,$139.12 ,$139.12 ,$51.15 ,$159.80 ,$20.46 ,$20.46 ,$131.79 ,$20.46 ,$78.21 , N/A ,$159.80 ,$43.99 ,$52.64 ,$169.20 ,$40.92 ,$20.46 ,$122.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600366,87109,HC CULTURE MYCOPLASMA-90,306,1 ,$163.00 ,$105.95 ,$15.39 ,$163.00 ,$105.95 ,$15.39 ,$45.64 ,$82.48 ,$15.39 ,$93.73 ,$15.39 ,$82.46 ,$15.39 ,$29.24 ,$133.66 ,$38.48 ,$15.39 ,$138.55 ,$146.70 ,$15.39 ,$122.25 ,$114.10 ,$120.62 ,$120.62 ,$38.48 ,$138.55 ,$15.39 ,$15.39 ,$114.26 ,$15.39 ,$67.81 , N/A ,$138.55 ,$33.09 ,$45.64 ,$146.70 ,$30.78 ,$15.39 ,$105.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600367,87110,HC CULTURE CHLAMYDIA-90,306,1 ,$102.00 ,$66.30 ,$19.60 ,$102.00 ,$66.30 ,$19.60 ,$28.56 ,$51.61 ,$19.60 ,$58.65 ,$19.60 ,$51.60 ,$19.60 ,$37.24 ,$83.64 ,$49.00 ,$19.60 ,$86.70 ,$91.80 ,$19.60 ,$76.50 ,$71.40 ,$75.48 ,$75.48 ,$49.00 ,$86.70 ,$19.60 ,$19.60 ,$71.50 ,$19.60 ,$42.43 , N/A ,$86.70 ,$42.14 ,$28.56 ,$91.80 ,$39.20 ,$19.60 ,$66.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600368,87116,HC CULTURE AFB/TB/MYCOBACT-90,306,1 ,$181.00 ,$117.65 ,$10.80 ,$181.00 ,$117.65 ,$10.80 ,$50.68 ,$91.59 ,$10.80 ,$104.08 ,$10.80 ,$91.57 ,$10.80 ,$20.52 ,$148.42 ,$27.00 ,$10.80 ,$153.85 ,$162.90 ,$10.80 ,$135.75 ,$126.70 ,$133.94 ,$133.94 ,$27.00 ,$153.85 ,$10.80 ,$10.80 ,$126.88 ,$10.80 ,$75.30 , N/A ,$153.85 ,$23.22 ,$50.68 ,$162.90 ,$21.60 ,$10.80 ,$117.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600370,87140,HC CULTURE TYPE IF EA ANTISERUM-90,306,1 ,$53.00 ,$34.45 ,$5.57 ,$53.00 ,$34.45 ,$5.57 ,$14.84 ,$26.82 ,$5.57 ,$30.48 ,$5.57 ,$26.81 ,$5.57 ,$10.58 ,$43.46 ,$13.93 ,$5.57 ,$45.05 ,$47.70 ,$5.57 ,$39.75 ,$37.10 ,$39.22 ,$39.22 ,$13.93 ,$45.05 ,$5.57 ,$5.57 ,$37.15 ,$5.57 ,$22.05 , N/A ,$45.05 ,$11.98 ,$14.84 ,$47.70 ,$11.14 ,$5.57 ,$34.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600380,87177,HC SMEAR OVA PARASITE CONC/ID-90,306,1 ,$227.00 ,$147.55 ,$8.90 ,$227.00 ,$147.55 ,$8.90 ,$63.56 ,$114.86 ,$8.90 ,$130.53 ,$8.90 ,$114.84 ,$8.90 ,$16.91 ,$186.14 ,$22.25 ,$8.90 ,$192.95 ,$204.30 ,$8.90 ,$170.25 ,$158.90 ,$167.98 ,$167.98 ,$22.25 ,$192.95 ,$8.90 ,$8.90 ,$159.13 ,$8.90 ,$94.43 , N/A ,$192.95 ,$19.14 ,$63.56 ,$204.30 ,$17.80 ,$8.90 ,$147.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600395,87206,HC SMEAR ACID FAST/FLUOR-90,306,1 ,$112.00 ,$72.80 ,$5.39 ,$112.00 ,$72.80 ,$5.39 ,$31.36 ,$56.67 ,$5.39 ,$64.40 ,$5.39 ,$56.66 ,$5.39 ,$10.24 ,$91.84 ,$13.48 ,$5.39 ,$95.20 ,$100.80 ,$5.39 ,$84.00 ,$78.40 ,$82.88 ,$82.88 ,$13.48 ,$95.20 ,$5.39 ,$5.39 ,$78.51 ,$5.39 ,$46.59 , N/A ,$95.20 ,$11.59 ,$31.36 ,$100.80 ,$10.78 ,$5.39 ,$72.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600397,87207,HC SPECIAL STAIN INCL BODIES/PARASITES-90,306,1 ,$116.00 ,$75.40 ,$5.99 ,$116.00 ,$75.40 ,$5.99 ,$32.48 ,$58.70 ,$5.99 ,$66.70 ,$5.99 ,$58.68 ,$5.99 ,$11.38 ,$95.12 ,$14.98 ,$5.99 ,$98.60 ,$104.40 ,$5.99 ,$87.00 ,$81.20 ,$85.84 ,$85.84 ,$14.98 ,$98.60 ,$5.99 ,$5.99 ,$81.32 ,$5.99 ,$48.26 , N/A ,$98.60 ,$12.88 ,$32.48 ,$104.40 ,$11.98 ,$5.99 ,$75.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600399,87209,HC OVA  AND  PARASITE W/STAIN-90,306,1 ,$145.00 ,$94.25 ,$17.98 ,$145.00 ,$94.25 ,$17.98 ,$40.60 ,$73.37 ,$17.98 ,$83.38 ,$17.98 ,$73.36 ,$17.98 ,$34.16 ,$118.90 ,$44.95 ,$17.98 ,$123.25 ,$130.50 ,$17.98 ,$108.75 ,$101.50 ,$107.30 ,$107.30 ,$44.95 ,$123.25 ,$17.98 ,$17.98 ,$101.65 ,$17.98 ,$60.32 , N/A ,$123.25 ,$38.66 ,$40.60 ,$130.50 ,$35.96 ,$17.98 ,$94.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600405,87254,HC VIRUS ISOL SHELL ID-90,306,1 ,$130.00 ,$84.50 ,$19.56 ,$130.00 ,$84.50 ,$19.56 ,$36.40 ,$65.78 ,$19.56 ,$74.75 ,$19.56 ,$65.77 ,$19.56 ,$37.16 ,$106.60 ,$48.90 ,$19.56 ,$110.50 ,$117.00 ,$19.56 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$48.90 ,$110.50 ,$19.56 ,$19.56 ,$91.13 ,$19.56 ,$54.08 , N/A ,$110.50 ,$42.05 ,$36.40 ,$117.00 ,$39.12 ,$19.56 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600407,87260,HC IF ADENOVIRUS AG-90,306,1 ,$238.00 ,$154.70 ,$14.43 ,$238.00 ,$154.70 ,$14.43 ,$66.64 ,$120.43 ,$14.43 ,$136.85 ,$14.43 ,$120.40 ,$14.43 ,$27.42 ,$195.16 ,$36.08 ,$14.43 ,$202.30 ,$214.20 ,$14.43 ,$178.50 ,$166.60 ,$176.12 ,$176.12 ,$36.08 ,$202.30 ,$14.43 ,$14.43 ,$166.84 ,$14.43 ,$99.01 , N/A ,$202.30 ,$31.02 ,$66.64 ,$214.20 ,$28.86 ,$14.43 ,$154.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600419,87338,HC EIA QL H PYLORI AG STOOL-90,306,1 ,$685.00 ,$445.25 ,$14.38 ,$685.00 ,$445.25 ,$14.38 ,$191.80 ,$346.61 ,$14.38 ,$393.88 ,$14.38 ,$346.54 ,$14.38 ,$27.32 ,$561.70 ,$35.95 ,$14.38 ,$582.25 ,$616.50 ,$14.38 ,$513.75 ,$479.50 ,$506.90 ,$506.90 ,$35.95 ,$582.25 ,$14.38 ,$14.38 ,$480.19 ,$14.38 ,$284.96 , N/A ,$582.25 ,$30.92 ,$191.80 ,$616.50 ,$28.76 ,$14.38 ,$445.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600424,87350,HC HEPATITIS BE AG QL-90,306,1 ,$139.00 ,$90.35 ,$11.53 ,$139.00 ,$90.35 ,$11.53 ,$38.92 ,$70.33 ,$11.53 ,$79.93 ,$11.53 ,$70.32 ,$11.53 ,$21.91 ,$113.98 ,$28.83 ,$11.53 ,$118.15 ,$125.10 ,$11.53 ,$104.25 ,$97.30 ,$102.86 ,$102.86 ,$28.83 ,$118.15 ,$11.53 ,$11.53 ,$97.44 ,$11.53 ,$57.82 , N/A ,$118.15 ,$24.79 ,$38.92 ,$125.10 ,$23.06 ,$11.53 ,$90.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600426,87385,HC EIA QL HISTOPLASMA AG-90,306,1 ,$408.00 ,$265.20 ,$13.25 ,$408.00 ,$265.20 ,$13.25 ,$114.24 ,$206.45 ,$13.25 ,$234.60 ,$13.25 ,$206.41 ,$13.25 ,$25.18 ,$334.56 ,$33.13 ,$13.25 ,$346.80 ,$367.20 ,$13.25 ,$306.00 ,$285.60 ,$301.92 ,$301.92 ,$33.13 ,$346.80 ,$13.25 ,$13.25 ,$286.01 ,$13.25 ,$169.73 , N/A ,$346.80 ,$28.49 ,$114.24 ,$367.20 ,$26.50 ,$13.25 ,$265.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600438,87491,HC CHLAMYDIA TRACH AMP-90,306,1 ,$63.00 ,$40.95 ,$17.64 ,$87.73 ,$40.95 ,$35.09 ,$17.64 ,$31.88 ,$35.09 ,$36.23 ,$35.09 ,$31.87 ,$35.09 ,$63.00 ,$51.66 ,$87.73 ,$35.09 ,$53.55 ,$56.70 ,$35.09 ,$47.25 ,$44.10 ,$46.62 ,$46.62 ,$63.00 ,$53.55 ,$35.09 ,$35.09 ,$44.16 ,$35.09 ,$26.21 , N/A ,$53.55 ,$75.44 ,$17.64 ,$56.70 ,$63.00 ,$35.09 ,$40.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600442,87496,HC INFECT AMP (CMV) MENI-90,306,1 ,$736.00 ,$478.40 ,$35.09 ,$736.00 ,$478.40 ,$35.09 ,$206.08 ,$372.42 ,$35.09 ,$423.20 ,$35.09 ,$372.34 ,$35.09 ,$66.67 ,$603.52 ,$87.73 ,$35.09 ,$625.60 ,$662.40 ,$35.09 ,$552.00 ,$515.20 ,$544.64 ,$544.64 ,$87.73 ,$625.60 ,$35.09 ,$35.09 ,$515.94 ,$35.09 ,$306.18 , N/A ,$625.60 ,$75.44 ,$206.08 ,$662.40 ,$70.18 ,$35.09 ,$478.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600443,87497,HC CMV QN-90,306,1 ,"$1,601.00 ","$1,040.65 ",$42.84 ,"$1,601.00 ","$1,040.65 ",$42.84 ,$448.28 ,$810.11 ,$42.84 ,$920.58 ,$42.84 ,$809.95 ,$42.84 ,$81.40 ,"$1,312.82 ",$107.10 ,$42.84 ,"$1,360.85 ","$1,440.90 ",$42.84 ,"$1,200.75 ","$1,120.70 ","$1,184.74 ","$1,184.74 ",$107.10 ,"$1,360.85 ",$42.84 ,$42.84 ,"$1,122.30 ",$42.84 ,$666.02 , N/A ,"$1,360.85 ",$92.11 ,$448.28 ,"$1,440.90 ",$85.68 ,$42.84 ,"$1,040.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600444,87498,HC ENTEROVIRUS AMP PROBE-90,306,1 ,$190.00 ,$123.50 ,$35.09 ,$190.00 ,$123.50 ,$35.09 ,$53.20 ,$96.14 ,$35.09 ,$109.25 ,$35.09 ,$96.12 ,$35.09 ,$66.67 ,$155.80 ,$87.73 ,$35.09 ,$161.50 ,$171.00 ,$35.09 ,$142.50 ,$133.00 ,$140.60 ,$140.60 ,$87.73 ,$161.50 ,$35.09 ,$35.09 ,$133.19 ,$35.09 ,$79.04 , N/A ,$161.50 ,$75.44 ,$53.20 ,$171.00 ,$70.18 ,$35.09 ,$123.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600448,87517,HC HEPATITIS B QN-90,306,1 ,"$1,381.00 ",$897.65 ,$42.84 ,"$1,381.00 ",$897.65 ,$42.84 ,$386.68 ,$698.79 ,$42.84 ,$794.08 ,$42.84 ,$698.65 ,$42.84 ,$81.40 ,"$1,132.42 ",$107.10 ,$42.84 ,"$1,173.85 ","$1,242.90 ",$42.84 ,"$1,035.75 ",$966.70 ,"$1,021.94 ","$1,021.94 ",$107.10 ,"$1,173.85 ",$42.84 ,$42.84 ,$968.08 ,$42.84 ,$574.50 , N/A ,"$1,173.85 ",$92.11 ,$386.68 ,"$1,242.90 ",$85.68 ,$42.84 ,$897.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600451,87522,HC HEPATITIS C QN-90,306,1 ,$729.00 ,$473.85 ,$42.84 ,$729.00 ,$473.85 ,$42.84 ,$204.12 ,$368.87 ,$42.84 ,$419.18 ,$42.84 ,$368.80 ,$42.84 ,$81.40 ,$597.78 ,$107.10 ,$42.84 ,$619.65 ,$656.10 ,$42.84 ,$546.75 ,$510.30 ,$539.46 ,$539.46 ,$107.10 ,$619.65 ,$42.84 ,$42.84 ,$511.03 ,$42.84 ,$303.26 , N/A ,$619.65 ,$92.11 ,$204.12 ,$656.10 ,$85.68 ,$42.84 ,$473.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600453,87529,HC HERPES SIMPLEX AMP-90,306,1 ,$704.00 ,$457.60 ,$35.09 ,$704.00 ,$457.60 ,$35.09 ,$197.12 ,$356.22 ,$35.09 ,$404.80 ,$35.09 ,$356.15 ,$35.09 ,$66.67 ,$577.28 ,$87.73 ,$35.09 ,$598.40 ,$633.60 ,$35.09 ,$528.00 ,$492.80 ,$520.96 ,$520.96 ,$87.73 ,$598.40 ,$35.09 ,$35.09 ,$493.50 ,$35.09 ,$292.86 , N/A ,$598.40 ,$75.44 ,$197.12 ,$633.60 ,$70.18 ,$35.09 ,$457.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600454,87530,HC HSV QUANT-90,306,1 ,$308.00 ,$200.20 ,$42.84 ,$308.00 ,$200.20 ,$42.84 ,$86.24 ,$155.85 ,$42.84 ,$177.10 ,$42.84 ,$155.82 ,$42.84 ,$81.40 ,$252.56 ,$107.10 ,$42.84 ,$261.80 ,$277.20 ,$42.84 ,$231.00 ,$215.60 ,$227.92 ,$227.92 ,$107.10 ,$261.80 ,$42.84 ,$42.84 ,$215.91 ,$42.84 ,$128.13 , N/A ,$261.80 ,$92.11 ,$86.24 ,$277.20 ,$85.68 ,$42.84 ,$200.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600458,87536,HC HIV-1 QN-90,306,1 ,$201.00 ,$130.65 ,$56.28 ,$212.75 ,$130.65 ,$85.10 ,$56.28 ,$101.71 ,$85.10 ,$115.58 ,$85.10 ,$101.69 ,$85.10 ,$161.69 ,$164.82 ,$212.75 ,$85.10 ,$170.85 ,$180.90 ,$85.10 ,$150.75 ,$140.70 ,$148.74 ,$148.74 ,$201.00 ,$170.85 ,$85.10 ,$85.10 ,$140.90 ,$85.10 ,$83.62 , N/A ,$170.85 ,$182.97 ,$56.28 ,$180.90 ,$170.20 ,$85.10 ,$130.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600460,87591,HC NEISSERIA AMP-90,306,1 ,$251.00 ,$163.15 ,$35.09 ,$251.00 ,$163.15 ,$35.09 ,$70.28 ,$127.01 ,$35.09 ,$144.33 ,$35.09 ,$126.98 ,$35.09 ,$66.67 ,$205.82 ,$87.73 ,$35.09 ,$213.35 ,$225.90 ,$35.09 ,$188.25 ,$175.70 ,$185.74 ,$185.74 ,$87.73 ,$213.35 ,$35.09 ,$35.09 ,$175.95 ,$35.09 ,$104.42 , N/A ,$213.35 ,$75.44 ,$70.28 ,$225.90 ,$70.18 ,$35.09 ,$163.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600462,87624,HC HPV AMP HIGH RISK ALL OTHERS-90,306,1 ,$284.00 ,$184.60 ,$35.09 ,$284.00 ,$184.60 ,$35.09 ,$79.52 ,$143.70 ,$35.09 ,$163.30 ,$35.09 ,$143.68 ,$35.09 ,$66.67 ,$232.88 ,$87.73 ,$35.09 ,$241.40 ,$255.60 ,$35.09 ,$213.00 ,$198.80 ,$210.16 ,$210.16 ,$87.73 ,$241.40 ,$35.09 ,$35.09 ,$199.08 ,$35.09 ,$118.14 , N/A ,$241.40 ,$75.44 ,$79.52 ,$255.60 ,$70.18 ,$35.09 ,$184.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600463,87625,HC HPV GENOTYPE 16 18/45-90,306,1 ,$258.00 ,$167.70 ,$40.55 ,$258.00 ,$167.70 ,$40.55 ,$72.24 ,$130.55 ,$40.55 ,$148.35 ,$40.55 ,$130.52 ,$40.55 ,$77.05 ,$211.56 ,$101.38 ,$40.55 ,$219.30 ,$232.20 ,$40.55 ,$193.50 ,$180.60 ,$190.92 ,$190.92 ,$101.38 ,$219.30 ,$40.55 ,$40.55 ,$180.86 ,$40.55 ,$107.33 , N/A ,$219.30 ,$87.18 ,$72.24 ,$232.20 ,$81.10 ,$40.55 ,$167.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600467,87651,HC INFECT AMP (GRP A STREP),306,1 ,$207.00 ,$134.55 ,$35.09 ,$207.00 ,$134.55 ,$35.09 ,$57.96 ,$104.74 ,$35.09 ,$119.03 ,$35.09 ,$104.72 ,$35.09 ,$66.67 ,$169.74 ,$87.73 ,$35.09 ,$175.95 ,$186.30 ,$35.09 ,$155.25 ,$144.90 ,$153.18 ,$153.18 ,$87.73 ,$175.95 ,$35.09 ,$35.09 ,$145.11 ,$35.09 ,$86.11 , N/A ,$175.95 ,$75.44 ,$57.96 ,$186.30 ,$70.18 ,$35.09 ,$134.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600469,87661,HC TRICHOMONAS VAG AMP PROBE-90,306,1 ,$252.00 ,$163.80 ,$35.09 ,$252.00 ,$163.80 ,$35.09 ,$70.56 ,$127.51 ,$35.09 ,$144.90 ,$35.09 ,$127.49 ,$35.09 ,$66.67 ,$206.64 ,$87.73 ,$35.09 ,$214.20 ,$226.80 ,$35.09 ,$189.00 ,$176.40 ,$186.48 ,$186.48 ,$87.73 ,$214.20 ,$35.09 ,$35.09 ,$176.65 ,$35.09 ,$104.83 , N/A ,$214.20 ,$75.44 ,$70.56 ,$226.80 ,$70.18 ,$35.09 ,$163.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600471,87798,HC INFECT AMP-90,306,1 ,$559.00 ,$363.35 ,$35.09 ,$559.00 ,$363.35 ,$35.09 ,$156.52 ,$282.85 ,$35.09 ,$321.43 ,$35.09 ,$282.80 ,$35.09 ,$66.67 ,$458.38 ,$87.73 ,$35.09 ,$475.15 ,$503.10 ,$35.09 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$87.73 ,$475.15 ,$35.09 ,$35.09 ,$391.86 ,$35.09 ,$232.54 , N/A ,$475.15 ,$75.44 ,$156.52 ,$503.10 ,$70.18 ,$35.09 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600478,87799,HC INFECT AGENT QN-90,306,1 ,$468.00 ,$304.20 ,$42.84 ,$468.00 ,$304.20 ,$42.84 ,$131.04 ,$236.81 ,$42.84 ,$269.10 ,$42.84 ,$236.76 ,$42.84 ,$81.40 ,$383.76 ,$107.10 ,$42.84 ,$397.80 ,$421.20 ,$42.84 ,$351.00 ,$327.60 ,$346.32 ,$346.32 ,$107.10 ,$397.80 ,$42.84 ,$42.84 ,$328.07 ,$42.84 ,$194.69 , N/A ,$397.80 ,$92.11 ,$131.04 ,$421.20 ,$85.68 ,$42.84 ,$304.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600483,87902,HC GENTOYPE HEP C-90,306,1 ,$720.00 ,$468.00 ,$201.60 ,$720.00 ,$468.00 ,$257.45 ,$201.60 ,$364.32 ,$257.45 ,$414.00 ,$257.45 ,$364.25 ,$257.45 ,$489.16 ,$590.40 ,$643.63 ,$257.45 ,$612.00 ,$648.00 ,$257.45 ,$540.00 ,$504.00 ,$532.80 ,$532.80 ,$643.63 ,$612.00 ,$257.45 ,$257.45 ,$504.72 ,$257.45 ,$299.52 , N/A ,$612.00 ,$553.52 ,$201.60 ,$648.00 ,$514.90 ,$257.45 ,$468.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600503,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB-90,306,1 ,$282.00 ,$183.30 ,$24.08 ,$282.00 ,$183.30 ,$24.08 ,$78.96 ,$142.69 ,$24.08 ,$162.15 ,$24.08 ,$142.66 ,$24.08 ,$45.75 ,$231.24 ,$60.20 ,$24.08 ,$239.70 ,$253.80 ,$24.08 ,$211.50 ,$197.40 ,$208.68 ,$208.68 ,$60.20 ,$239.70 ,$24.08 ,$24.08 ,$197.68 ,$24.08 ,$117.31 , N/A ,$239.70 ,$51.77 ,$78.96 ,$253.80 ,$48.16 ,$24.08 ,$183.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600516,87040,HC BACTERIA BLOOD CULTURE T1,306,1 ,$295.00 ,$191.75 ,$10.32 ,$295.00 ,$191.75 ,$10.32 ,$82.60 ,$149.27 ,$10.32 ,$169.63 ,$10.32 ,$149.24 ,$10.32 ,$19.61 ,$241.90 ,$25.80 ,$10.32 ,$250.75 ,$265.50 ,$10.32 ,$221.25 ,$206.50 ,$218.30 ,$218.30 ,$25.80 ,$250.75 ,$10.32 ,$10.32 ,$206.80 ,$10.32 ,$122.72 , N/A ,$250.75 ,$22.19 ,$82.60 ,$265.50 ,$20.64 ,$10.32 ,$191.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600519,87070,HC BODY FLUID CULTURE,306,1 ,$41.00 ,$26.65 ,$8.62 ,$41.00 ,$26.65 ,$8.62 ,$11.48 ,$20.75 ,$8.62 ,$23.58 ,$8.62 ,$20.74 ,$8.62 ,$16.38 ,$33.62 ,$21.55 ,$8.62 ,$34.85 ,$36.90 ,$8.62 ,$30.75 ,$28.70 ,$30.34 ,$30.34 ,$21.55 ,$34.85 ,$8.62 ,$8.62 ,$28.74 ,$8.62 ,$17.06 , N/A ,$34.85 ,$18.53 ,$11.48 ,$36.90 ,$17.24 ,$8.62 ,$26.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600522,87075,HC CULTURE ANAEROBIC,306,1 ,$244.00 ,$158.60 ,$9.47 ,$244.00 ,$158.60 ,$9.47 ,$68.32 ,$123.46 ,$9.47 ,$140.30 ,$9.47 ,$123.44 ,$9.47 ,$17.99 ,$200.08 ,$23.68 ,$9.47 ,$207.40 ,$219.60 ,$9.47 ,$183.00 ,$170.80 ,$180.56 ,$180.56 ,$23.68 ,$207.40 ,$9.47 ,$9.47 ,$171.04 ,$9.47 ,$101.50 , N/A ,$207.40 ,$20.36 ,$68.32 ,$219.60 ,$18.94 ,$9.47 ,$158.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600523,87076,HC CULTURE ANAEROBIC ID,306,1 ,$156.00 ,$101.40 ,$8.08 ,$156.00 ,$101.40 ,$8.08 ,$43.68 ,$78.94 ,$8.08 ,$89.70 ,$8.08 ,$78.92 ,$8.08 ,$15.35 ,$127.92 ,$20.20 ,$8.08 ,$132.60 ,$140.40 ,$8.08 ,$117.00 ,$109.20 ,$115.44 ,$115.44 ,$20.20 ,$132.60 ,$8.08 ,$8.08 ,$109.36 ,$8.08 ,$64.90 , N/A ,$132.60 ,$17.37 ,$43.68 ,$140.40 ,$16.16 ,$8.08 ,$101.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600524,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$213.00 ,$138.45 ,$8.08 ,$213.00 ,$138.45 ,$8.08 ,$59.64 ,$107.78 ,$8.08 ,$122.48 ,$8.08 ,$107.76 ,$8.08 ,$15.35 ,$174.66 ,$20.20 ,$8.08 ,$181.05 ,$191.70 ,$8.08 ,$159.75 ,$149.10 ,$157.62 ,$157.62 ,$20.20 ,$181.05 ,$8.08 ,$8.08 ,$149.31 ,$8.08 ,$88.61 , N/A ,$181.05 ,$17.37 ,$59.64 ,$191.70 ,$16.16 ,$8.08 ,$138.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600526,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$153.00 ,$99.45 ,$6.63 ,$153.00 ,$99.45 ,$6.63 ,$42.84 ,$77.42 ,$6.63 ,$87.98 ,$6.63 ,$77.40 ,$6.63 ,$12.60 ,$125.46 ,$16.58 ,$6.63 ,$130.05 ,$137.70 ,$6.63 ,$114.75 ,$107.10 ,$113.22 ,$113.22 ,$16.58 ,$130.05 ,$6.63 ,$6.63 ,$107.25 ,$6.63 ,$63.65 , N/A ,$130.05 ,$14.25 ,$42.84 ,$137.70 ,$13.26 ,$6.63 ,$99.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600527,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$174.00 ,$113.10 ,$8.07 ,$174.00 ,$113.10 ,$8.07 ,$48.72 ,$88.04 ,$8.07 ,$100.05 ,$8.07 ,$88.03 ,$8.07 ,$15.33 ,$142.68 ,$20.18 ,$8.07 ,$147.90 ,$156.60 ,$8.07 ,$130.50 ,$121.80 ,$128.76 ,$128.76 ,$20.18 ,$147.90 ,$8.07 ,$8.07 ,$121.97 ,$8.07 ,$72.38 , N/A ,$147.90 ,$17.35 ,$48.72 ,$156.60 ,$16.14 ,$8.07 ,$113.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600528,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$98.00 ,$63.70 ,$8.09 ,$98.00 ,$63.70 ,$8.09 ,$27.44 ,$49.59 ,$8.09 ,$56.35 ,$8.09 ,$49.58 ,$8.09 ,$15.37 ,$80.36 ,$20.23 ,$8.09 ,$83.30 ,$88.20 ,$8.09 ,$73.50 ,$68.60 ,$72.52 ,$72.52 ,$20.23 ,$83.30 ,$8.09 ,$8.09 ,$68.70 ,$8.09 ,$40.77 , N/A ,$83.30 ,$17.39 ,$27.44 ,$88.20 ,$16.18 ,$8.09 ,$63.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600530,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$83.00 ,$53.95 ,$7.71 ,$83.00 ,$53.95 ,$7.71 ,$23.24 ,$42.00 ,$7.71 ,$47.73 ,$7.71 ,$41.99 ,$7.71 ,$14.65 ,$68.06 ,$19.28 ,$7.71 ,$70.55 ,$74.70 ,$7.71 ,$62.25 ,$58.10 ,$61.42 ,$61.42 ,$19.28 ,$70.55 ,$7.71 ,$7.71 ,$58.18 ,$7.71 ,$34.53 , N/A ,$70.55 ,$16.58 ,$23.24 ,$74.70 ,$15.42 ,$7.71 ,$53.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600531,87102,HC CULTURE FUNGUS OTHER,306,1 ,$210.00 ,$136.50 ,$8.41 ,$210.00 ,$136.50 ,$8.41 ,$58.80 ,$106.26 ,$8.41 ,$120.75 ,$8.41 ,$106.24 ,$8.41 ,$15.98 ,$172.20 ,$21.03 ,$8.41 ,$178.50 ,$189.00 ,$8.41 ,$157.50 ,$147.00 ,$155.40 ,$155.40 ,$21.03 ,$178.50 ,$8.41 ,$8.41 ,$147.21 ,$8.41 ,$87.36 , N/A ,$178.50 ,$18.08 ,$58.80 ,$189.00 ,$16.82 ,$8.41 ,$136.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600533,87106,HC CULTURE FUNGUS ID YEAST,306,1 ,$163.00 ,$105.95 ,$10.32 ,$163.00 ,$105.95 ,$10.32 ,$45.64 ,$82.48 ,$10.32 ,$93.73 ,$10.32 ,$82.46 ,$10.32 ,$19.61 ,$133.66 ,$25.80 ,$10.32 ,$138.55 ,$146.70 ,$10.32 ,$122.25 ,$114.10 ,$120.62 ,$120.62 ,$25.80 ,$138.55 ,$10.32 ,$10.32 ,$114.26 ,$10.32 ,$67.81 , N/A ,$138.55 ,$22.19 ,$45.64 ,$146.70 ,$20.64 ,$10.32 ,$105.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600536,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$175.00 ,$113.75 ,$5.18 ,$175.00 ,$113.75 ,$5.18 ,$49.00 ,$88.55 ,$5.18 ,$100.63 ,$5.18 ,$88.53 ,$5.18 ,$9.84 ,$143.50 ,$12.95 ,$5.18 ,$148.75 ,$157.50 ,$5.18 ,$131.25 ,$122.50 ,$129.50 ,$129.50 ,$12.95 ,$148.75 ,$5.18 ,$5.18 ,$122.68 ,$5.18 ,$72.80 , N/A ,$148.75 ,$11.14 ,$49.00 ,$157.50 ,$10.36 ,$5.18 ,$113.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600537,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$94.00 ,$61.10 ,$20.05 ,$94.00 ,$61.10 ,$20.05 ,$26.32 ,$47.56 ,$20.05 ,$54.05 ,$20.05 ,$47.55 ,$20.05 ,$38.10 ,$77.08 ,$50.13 ,$20.05 ,$79.90 ,$84.60 ,$20.05 ,$70.50 ,$65.80 ,$69.56 ,$69.56 ,$50.13 ,$79.90 ,$20.05 ,$20.05 ,$65.89 ,$20.05 ,$39.10 , N/A ,$79.90 ,$43.11 ,$26.32 ,$84.60 ,$40.10 ,$20.05 ,$61.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600542,87176,HC HOMOGENIZATION TISSUE,306,1 ,$75.00 ,$48.75 ,$5.88 ,$75.00 ,$48.75 ,$5.88 ,$21.00 ,$37.95 ,$5.88 ,$43.13 ,$5.88 ,$37.94 ,$5.88 ,$11.17 ,$61.50 ,$14.70 ,$5.88 ,$63.75 ,$67.50 ,$5.88 ,$56.25 ,$52.50 ,$55.50 ,$55.50 ,$14.70 ,$63.75 ,$5.88 ,$5.88 ,$52.58 ,$5.88 ,$31.20 , N/A ,$63.75 ,$12.64 ,$21.00 ,$67.50 ,$11.76 ,$5.88 ,$48.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600544,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$27.00 ,$17.55 ,$4.75 ,$27.00 ,$17.55 ,$4.75 ,$7.56 ,$13.66 ,$4.75 ,$15.53 ,$4.75 ,$13.66 ,$4.75 ,$9.03 ,$22.14 ,$11.88 ,$4.75 ,$22.95 ,$24.30 ,$4.75 ,$20.25 ,$18.90 ,$19.98 ,$19.98 ,$11.88 ,$22.95 ,$4.75 ,$4.75 ,$18.93 ,$4.75 ,$11.23 , N/A ,$22.95 ,$10.21 ,$7.56 ,$24.30 ,$9.50 ,$4.75 ,$17.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600545,87184,HC SENSITIVITY DISK KB,306,1 ,$96.00 ,$62.40 ,$7.48 ,$96.00 ,$62.40 ,$7.48 ,$26.88 ,$48.58 ,$7.48 ,$55.20 ,$7.48 ,$48.57 ,$7.48 ,$14.21 ,$78.72 ,$18.70 ,$7.48 ,$81.60 ,$86.40 ,$7.48 ,$72.00 ,$67.20 ,$71.04 ,$71.04 ,$18.70 ,$81.60 ,$7.48 ,$7.48 ,$67.30 ,$7.48 ,$39.94 , N/A ,$81.60 ,$16.08 ,$26.88 ,$86.40 ,$14.96 ,$7.48 ,$62.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600546,87185,HC BETA LACTAMASE,306,1 ,$19.00 ,$12.35 ,$4.75 ,$19.00 ,$12.35 ,$4.75 ,$5.32 ,$9.61 ,$4.75 ,$10.93 ,$4.75 ,$9.61 ,$4.75 ,$9.03 ,$15.58 ,$11.88 ,$4.75 ,$16.15 ,$17.10 ,$4.75 ,$14.25 ,$13.30 ,$14.06 ,$14.06 ,$11.88 ,$16.15 ,$4.75 ,$4.75 ,$13.32 ,$4.75 ,$7.90 , N/A ,$16.15 ,$10.21 ,$5.32 ,$17.10 ,$9.50 ,$4.75 ,$12.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600547,87186,HC SENSITIVITY MIC,306,1 ,$194.00 ,$126.10 ,$8.65 ,$194.00 ,$126.10 ,$8.65 ,$54.32 ,$98.16 ,$8.65 ,$111.55 ,$8.65 ,$98.14 ,$8.65 ,$16.44 ,$159.08 ,$21.63 ,$8.65 ,$164.90 ,$174.60 ,$8.65 ,$145.50 ,$135.80 ,$143.56 ,$143.56 ,$21.63 ,$164.90 ,$8.65 ,$8.65 ,$135.99 ,$8.65 ,$80.70 , N/A ,$164.90 ,$18.60 ,$54.32 ,$174.60 ,$17.30 ,$8.65 ,$126.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600551,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$126.00 ,$81.90 ,$4.27 ,$126.00 ,$81.90 ,$4.27 ,$35.28 ,$63.76 ,$4.27 ,$72.45 ,$4.27 ,$63.74 ,$4.27 ,$8.11 ,$103.32 ,$10.68 ,$4.27 ,$107.10 ,$113.40 ,$4.27 ,$94.50 ,$88.20 ,$93.24 ,$93.24 ,$10.68 ,$107.10 ,$4.27 ,$4.27 ,$88.33 ,$4.27 ,$52.42 , N/A ,$107.10 ,$9.18 ,$35.28 ,$113.40 ,$8.54 ,$4.27 ,$81.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600552,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$79.00 ,$51.35 ,$5.39 ,$79.00 ,$51.35 ,$5.39 ,$22.12 ,$39.97 ,$5.39 ,$45.43 ,$5.39 ,$39.97 ,$5.39 ,$10.24 ,$64.78 ,$13.48 ,$5.39 ,$67.15 ,$71.10 ,$5.39 ,$59.25 ,$55.30 ,$58.46 ,$58.46 ,$13.48 ,$67.15 ,$5.39 ,$5.39 ,$55.38 ,$5.39 ,$32.86 , N/A ,$67.15 ,$11.59 ,$22.12 ,$71.10 ,$10.78 ,$5.39 ,$51.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600555,87255,HC VIRUS ID NON-IMMUNOLOGIC OTHER THAN CYTOPATHIC-90,306,1 ,$358.00 ,$232.70 ,$33.86 ,$358.00 ,$232.70 ,$33.86 ,$100.24 ,$181.15 ,$33.86 ,$205.85 ,$33.86 ,$181.11 ,$33.86 ,$64.33 ,$293.56 ,$84.65 ,$33.86 ,$304.30 ,$322.20 ,$33.86 ,$268.50 ,$250.60 ,$264.92 ,$264.92 ,$84.65 ,$304.30 ,$33.86 ,$33.86 ,$250.96 ,$33.86 ,$148.93 , N/A ,$304.30 ,$72.80 ,$100.24 ,$322.20 ,$67.72 ,$33.86 ,$232.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600559,87340,HC EIA QL HEPATITIS B AG,306,1 ,$302.00 ,$196.30 ,$10.33 ,$302.00 ,$196.30 ,$10.33 ,$84.56 ,$152.81 ,$10.33 ,$173.65 ,$10.33 ,$152.78 ,$10.33 ,$19.63 ,$247.64 ,$25.83 ,$10.33 ,$256.70 ,$271.80 ,$10.33 ,$226.50 ,$211.40 ,$223.48 ,$223.48 ,$25.83 ,$256.70 ,$10.33 ,$10.33 ,$211.70 ,$10.33 ,$125.63 , N/A ,$256.70 ,$22.21 ,$84.56 ,$271.80 ,$20.66 ,$10.33 ,$196.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600561,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$282.00 ,$183.30 ,$24.08 ,$282.00 ,$183.30 ,$24.08 ,$78.96 ,$142.69 ,$24.08 ,$162.15 ,$24.08 ,$142.66 ,$24.08 ,$45.75 ,$231.24 ,$60.20 ,$24.08 ,$239.70 ,$253.80 ,$24.08 ,$211.50 ,$197.40 ,$208.68 ,$208.68 ,$60.20 ,$239.70 ,$24.08 ,$24.08 ,$197.68 ,$24.08 ,$117.31 , N/A ,$239.70 ,$51.77 ,$78.96 ,$253.80 ,$48.16 ,$24.08 ,$183.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600568,87486,HC CHLAMYDIA PNEUM AMP PROBE,306,1 ,$121.00 ,$78.65 ,$33.88 ,$121.00 ,$78.65 ,$35.09 ,$33.88 ,$61.23 ,$35.09 ,$69.58 ,$35.09 ,$61.21 ,$35.09 ,$66.67 ,$99.22 ,$87.73 ,$35.09 ,$102.85 ,$108.90 ,$35.09 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$87.73 ,$102.85 ,$35.09 ,$35.09 ,$84.82 ,$35.09 ,$50.34 , N/A ,$102.85 ,$75.44 ,$33.88 ,$108.90 ,$70.18 ,$35.09 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600571,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,$700.00 ,$455.00 ,$196.00 ,"$1,041.95 ",$455.00 ,$416.78 ,$196.00 ,$354.20 ,$416.78 ,$402.50 ,$416.78 ,$354.13 ,$416.78 ,$700.00 ,$574.00 ,"$1,041.95 ",$416.78 ,$595.00 ,$630.00 ,$416.78 ,$525.00 ,$490.00 ,$518.00 ,$518.00 ,$700.00 ,$595.00 ,$416.78 ,$416.78 ,$490.70 ,$416.78 ,$291.20 , N/A ,$595.00 ,$896.08 ,$196.00 ,$630.00 ,$700.00 ,$416.78 ,$455.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600573,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$531.00 ,$345.15 ,$35.09 ,$531.00 ,$345.15 ,$35.09 ,$148.68 ,$268.69 ,$35.09 ,$305.33 ,$35.09 ,$268.63 ,$35.09 ,$66.67 ,$435.42 ,$87.73 ,$35.09 ,$451.35 ,$477.90 ,$35.09 ,$398.25 ,$371.70 ,$392.94 ,$392.94 ,$87.73 ,$451.35 ,$35.09 ,$35.09 ,$372.23 ,$35.09 ,$220.90 , N/A ,$451.35 ,$75.44 ,$148.68 ,$477.90 ,$70.18 ,$35.09 ,$345.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600577,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,$491.00 ,$319.15 ,$137.48 ,"$1,041.95 ",$319.15 ,$416.78 ,$137.48 ,$248.45 ,$416.78 ,$282.33 ,$416.78 ,$248.40 ,$416.78 ,$491.00 ,$402.62 ,"$1,041.95 ",$416.78 ,$417.35 ,$441.90 ,$416.78 ,$368.25 ,$343.70 ,$363.34 ,$363.34 ,$491.00 ,$417.35 ,$416.78 ,$416.78 ,$344.19 ,$416.78 ,$204.26 , N/A ,$417.35 ,$896.08 ,$137.48 ,$441.90 ,$491.00 ,$416.78 ,$319.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600581,87798,HC INFECT AMP,306,1 ,$508.00 ,$330.20 ,$35.09 ,$508.00 ,$330.20 ,$35.09 ,$142.24 ,$257.05 ,$35.09 ,$292.10 ,$35.09 ,$257.00 ,$35.09 ,$66.67 ,$416.56 ,$87.73 ,$35.09 ,$431.80 ,$457.20 ,$35.09 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$87.73 ,$431.80 ,$35.09 ,$35.09 ,$356.11 ,$35.09 ,$211.33 , N/A ,$431.80 ,$75.44 ,$142.24 ,$457.20 ,$70.18 ,$35.09 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600592,87486,HC CHLAMYDIA PNEUM AMP PROBE-90,306,1 ,$412.00 ,$267.80 ,$35.09 ,$412.00 ,$267.80 ,$35.09 ,$115.36 ,$208.47 ,$35.09 ,$236.90 ,$35.09 ,$208.43 ,$35.09 ,$66.67 ,$337.84 ,$87.73 ,$35.09 ,$350.20 ,$370.80 ,$35.09 ,$309.00 ,$288.40 ,$304.88 ,$304.88 ,$87.73 ,$350.20 ,$35.09 ,$35.09 ,$288.81 ,$35.09 ,$171.39 , N/A ,$350.20 ,$75.44 ,$115.36 ,$370.80 ,$70.18 ,$35.09 ,$267.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600593,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$434.00 ,$282.10 ,$16.07 ,$434.00 ,$282.10 ,$16.07 ,$121.52 ,$219.60 ,$16.07 ,$249.55 ,$16.07 ,$219.56 ,$16.07 ,$30.53 ,$355.88 ,$40.18 ,$16.07 ,$368.90 ,$390.60 ,$16.07 ,$325.50 ,$303.80 ,$321.16 ,$321.16 ,$40.18 ,$368.90 ,$16.07 ,$16.07 ,$304.23 ,$16.07 ,$180.54 , N/A ,$368.90 ,$34.55 ,$121.52 ,$390.60 ,$32.14 ,$16.07 ,$282.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600614,87220,HC TISSUE KOH PREP,306,1 ,$70.00 ,$45.50 ,$4.27 ,$70.00 ,$45.50 ,$4.27 ,$19.60 ,$35.42 ,$4.27 ,$40.25 ,$4.27 ,$35.41 ,$4.27 ,$8.11 ,$57.40 ,$10.68 ,$4.27 ,$59.50 ,$63.00 ,$4.27 ,$52.50 ,$49.00 ,$51.80 ,$51.80 ,$10.68 ,$59.50 ,$4.27 ,$4.27 ,$49.07 ,$4.27 ,$29.12 , N/A ,$59.50 ,$9.18 ,$19.60 ,$63.00 ,$8.54 ,$4.27 ,$45.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30600636,87811,HC COVID ANTIGEN TEST,306,1 ,$125.00 ,$81.25 ,$35.00 ,$125.00 ,$81.25 ,$41.38 ,$35.00 ,$63.25 ,$41.38 ,$71.88 ,$41.38 ,$63.24 ,$41.38 ,$78.62 ,$102.50 ,$103.45 ,$41.38 ,$106.25 ,$112.50 ,$41.38 ,$93.75 ,$87.50 ,$92.50 ,$92.50 ,$103.45 ,$106.25 ,$41.38 ,$41.38 ,$87.63 ,$41.38 ,$52.00 , N/A ,$106.25 ,$88.97 ,$35.00 ,$112.50 ,$83.04 ,$41.38 ,$81.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30682004,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$15.00 ,$9.75 ,$4.20 ,$37.50 ,$9.75 ,$15.00 ,$4.20 ,$7.59 ,$15.00 ,$8.63 ,$15.00 ,$7.59 ,$15.00 ,$15.00 ,$12.30 ,$37.50 ,$15.00 ,$12.75 ,$13.50 ,$15.00 ,$11.25 ,$10.50 ,$11.10 ,$11.10 ,$15.00 ,$12.75 ,$15.00 ,$15.00 ,$10.52 ,$15.00 ,$6.24 , N/A ,$12.75 ,$32.25 ,$4.20 ,$13.50 ,$15.00 ,$15.00 ,$9.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30682012,87635,HC COVID-19 LAB TEST,306,1 ,$458.00 ,$297.70 ,$51.31 ,$458.00 ,$297.70 ,$51.31 ,$128.24 ,$231.75 ,$51.31 ,$263.35 ,$51.31 ,$231.70 ,$51.31 ,$97.49 ,$375.56 ,$128.28 ,$51.31 ,$389.30 ,$412.20 ,$51.31 ,$343.50 ,$320.60 ,$338.92 ,$338.92 ,$128.28 ,$389.30 ,$51.31 ,$51.31 ,$321.06 ,$51.31 ,$190.53 , N/A ,$389.30 ,$110.32 ,$128.24 ,$412.20 ,$102.62 ,$51.31 ,$297.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30682015,86769,HC SARS-COV-2 COVID-19 ANTIBODY-90,306,1 ,$260.00 ,$169.00 ,$42.13 ,$260.00 ,$169.00 ,$42.13 ,$72.80 ,$131.56 ,$42.13 ,$149.50 ,$42.13 ,$131.53 ,$42.13 ,$80.05 ,$213.20 ,$105.33 ,$42.13 ,$221.00 ,$234.00 ,$42.13 ,$195.00 ,$182.00 ,$192.40 ,$192.40 ,$105.33 ,$221.00 ,$42.13 ,$42.13 ,$182.26 ,$42.13 ,$108.16 , N/A ,$221.00 ,$90.58 ,$72.80 ,$234.00 ,$84.26 ,$42.13 ,$169.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$120.00 ,$78.00 ,$3.17 ,$120.00 ,$78.00 ,$3.17 ,$33.60 ,$60.72 ,$3.17 ,$69.00 ,$3.17 ,$60.71 ,$3.17 ,$6.02 ,$98.40 ,$7.93 ,$3.17 ,$102.00 ,$108.00 ,$3.17 ,$90.00 ,$84.00 ,$88.80 ,$88.80 ,$7.93 ,$102.00 ,$3.17 ,$3.17 ,$84.12 ,$3.17 ,$49.92 , N/A ,$102.00 ,$6.82 ,$33.60 ,$108.00 ,$6.34 ,$3.17 ,$78.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$94.00 ,$61.10 ,$2.25 ,$94.00 ,$61.10 ,$2.25 ,$26.32 ,$47.56 ,$2.25 ,$54.05 ,$2.25 ,$47.55 ,$2.25 ,$4.28 ,$77.08 ,$5.63 ,$2.25 ,$79.90 ,$84.60 ,$2.25 ,$70.50 ,$65.80 ,$69.56 ,$69.56 ,$5.63 ,$79.90 ,$2.25 ,$2.25 ,$65.89 ,$2.25 ,$39.10 , N/A ,$79.90 ,$4.84 ,$26.32 ,$84.60 ,$4.50 ,$2.25 ,$61.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$178.00 ,$115.70 ,$8.61 ,$178.00 ,$115.70 ,$8.61 ,$49.84 ,$90.07 ,$8.61 ,$102.35 ,$8.61 ,$90.05 ,$8.61 ,$16.36 ,$145.96 ,$21.53 ,$8.61 ,$151.30 ,$160.20 ,$8.61 ,$133.50 ,$124.60 ,$131.72 ,$131.72 ,$21.53 ,$151.30 ,$8.61 ,$8.61 ,$124.78 ,$8.61 ,$74.05 , N/A ,$151.30 ,$18.51 ,$49.84 ,$160.20 ,$17.22 ,$8.61 ,$115.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),30700117,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$38.00 ,$24.70 ,$3.64 ,$38.00 ,$24.70 ,$3.64 ,$10.64 ,$19.23 ,$3.64 ,$21.85 ,$3.64 ,$19.22 ,$3.64 ,$6.92 ,$31.16 ,$9.10 ,$3.64 ,$32.30 ,$34.20 ,$3.64 ,$28.50 ,$26.60 ,$28.12 ,$28.12 ,$9.10 ,$32.30 ,$3.64 ,$3.64 ,$26.64 ,$3.64 ,$15.81 , N/A ,$32.30 ,$7.83 ,$10.64 ,$34.20 ,$7.28 ,$3.64 ,$24.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000129,81206,HC BCR/ABL1 GENE MAJOR BP QL/QN DIAG -90,310,1 ,$867.00 ,$563.55 ,$163.96 ,$867.00 ,$563.55 ,$163.96 ,$242.76 ,$438.70 ,$163.96 ,$498.53 ,$163.96 ,$438.62 ,$163.96 ,$311.52 ,$710.94 ,$409.90 ,$163.96 ,$736.95 ,$780.30 ,$163.96 ,$650.25 ,$606.90 ,$641.58 ,$641.58 ,$409.90 ,$736.95 ,$163.96 ,$163.96 ,$607.77 ,$163.96 ,$360.67 , N/A ,$736.95 ,$352.51 ,$242.76 ,$780.30 ,$327.92 ,$163.96 ,$563.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000131,81207,HC BCR/ABL1 GENE MINOR BP DIAG -90,310,1 ,$604.00 ,$392.60 ,$144.84 ,$604.00 ,$392.60 ,$144.84 ,$169.12 ,$305.62 ,$144.84 ,$347.30 ,$144.84 ,$305.56 ,$144.84 ,$275.20 ,$495.28 ,$362.10 ,$144.84 ,$513.40 ,$543.60 ,$144.84 ,$453.00 ,$422.80 ,$446.96 ,$446.96 ,$362.10 ,$513.40 ,$144.84 ,$144.84 ,$423.40 ,$144.84 ,$251.26 , N/A ,$513.40 ,$311.41 ,$169.12 ,$543.60 ,$289.68 ,$144.84 ,$392.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000137,81220,HC CYSTIC FIBROSIS GENE COMMON VARIANTS -90,310,1 ,$340.00 ,$221.00 ,$95.20 ,$850.00 ,$221.00 ,$340.00 ,$95.20 ,$172.04 ,$340.00 ,$195.50 ,$340.00 ,$172.01 ,$340.00 ,$340.00 ,$278.80 ,$850.00 ,$340.00 ,$289.00 ,$306.00 ,$340.00 ,$255.00 ,$238.00 ,$251.60 ,$251.60 ,$340.00 ,$289.00 ,$340.00 ,$340.00 ,$238.34 ,$340.00 ,$141.44 , N/A ,$289.00 ,$731.00 ,$95.20 ,$306.00 ,$340.00 ,$340.00 ,$221.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000139,81229,HC CYTOGENOMIC MICROARRY ASSAY-90,310,1 ,"$1,254.00 ",$815.10 ,$351.12 ,"$2,900.00 ",$815.10 ,"$1,160.00 ",$351.12 ,$634.52 ,"$1,160.00 ",$721.05 ,"$1,160.00 ",$634.40 ,"$1,160.00 ","$1,254.00 ","$1,028.28 ","$2,900.00 ","$1,160.00 ","$1,065.90 ","$1,128.60 ","$1,160.00 ",$940.50 ,$877.80 ,$927.96 ,$927.96 ,"$1,254.00 ","$1,065.90 ","$1,160.00 ","$1,160.00 ",$879.05 ,"$1,160.00 ",$521.66 , N/A ,"$1,065.90 ","$2,494.00 ",$351.12 ,"$1,128.60 ","$1,254.00 ","$1,160.00 ",$815.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000143,81240,HC F2 GENE ANAL 20210G A VAR -90,310,1 ,$196.00 ,$127.40 ,$54.88 ,$196.00 ,$127.40 ,$65.69 ,$54.88 ,$99.18 ,$65.69 ,$112.70 ,$65.69 ,$99.16 ,$65.69 ,$124.81 ,$160.72 ,$164.23 ,$65.69 ,$166.60 ,$176.40 ,$65.69 ,$147.00 ,$137.20 ,$145.04 ,$145.04 ,$164.23 ,$166.60 ,$65.69 ,$65.69 ,$137.40 ,$65.69 ,$81.54 , N/A ,$166.60 ,$141.23 ,$54.88 ,$176.40 ,$131.38 ,$65.69 ,$127.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000145,81241,HC F5 GENE ANAL LEIDEN VAR -90,310,1 ,$379.00 ,$246.35 ,$73.37 ,$379.00 ,$246.35 ,$73.37 ,$106.12 ,$191.77 ,$73.37 ,$217.93 ,$73.37 ,$191.74 ,$73.37 ,$139.40 ,$310.78 ,$183.43 ,$73.37 ,$322.15 ,$341.10 ,$73.37 ,$284.25 ,$265.30 ,$280.46 ,$280.46 ,$183.43 ,$322.15 ,$73.37 ,$73.37 ,$265.68 ,$73.37 ,$157.66 , N/A ,$322.15 ,$157.75 ,$106.12 ,$341.10 ,$146.74 ,$73.37 ,$246.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000146,81243,HC FMR1 GENE DETECTION -90,310,1 ,$394.00 ,$256.10 ,$110.32 ,$394.00 ,$256.10 , N/A ,$110.32 ,$199.36 , N/A ,$226.55 , N/A ,$199.32 , N/A ,$177.30 ,$323.08 ,$275.80 , N/A ,$334.90 ,$354.60 , N/A ,$295.50 ,$275.80 ,$291.56 ,$291.56 , N/A ,$334.90 , N/A , N/A ,$276.19 , N/A ,$163.90 , N/A ,$334.90 ,$236.40 ,$110.32 ,$354.60 ,$114.08 , N/A ,$256.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000147,81244,HC FMR1 GENE CHARACTERIZATION - 90,310,1 ,$227.00 ,$147.55 ,$44.89 ,$227.00 ,$147.55 ,$44.89 ,$63.56 ,$114.86 ,$44.89 ,$130.53 ,$44.89 ,$114.84 ,$44.89 ,$85.29 ,$186.14 ,$112.23 ,$44.89 ,$192.95 ,$204.30 ,$44.89 ,$170.25 ,$158.90 ,$167.98 ,$167.98 ,$112.23 ,$192.95 ,$44.89 ,$44.89 ,$159.13 ,$44.89 ,$94.43 , N/A ,$192.95 ,$96.51 ,$63.56 ,$204.30 ,$89.78 ,$44.89 ,$147.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000157,81291,HC MTHFR GENE ANALYSIS-90,310,1 ,$768.00 ,$499.20 ,$65.34 ,$768.00 ,$499.20 ,$65.34 ,$215.04 ,$388.61 ,$65.34 ,$441.60 ,$65.34 ,$388.53 ,$65.34 ,$124.15 ,$629.76 ,$163.35 ,$65.34 ,$652.80 ,$691.20 ,$65.34 ,$576.00 ,$537.60 ,$568.32 ,$568.32 ,$163.35 ,$652.80 ,$65.34 ,$65.34 ,$538.37 ,$65.34 ,$319.49 , N/A ,$652.80 ,$140.48 ,$215.04 ,$691.20 ,$130.68 ,$65.34 ,$499.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000174,81372,HC CLASS 1 TYPING COMPLETE LOW RESOLUTION-90,310,1 ,$757.00 ,$492.05 ,$211.96 ,"$1,008.98 ",$492.05 ,$403.59 ,$211.96 ,$383.04 ,$403.59 ,$435.28 ,$403.59 ,$382.97 ,$403.59 ,$757.00 ,$620.74 ,"$1,008.98 ",$403.59 ,$643.45 ,$681.30 ,$403.59 ,$567.75 ,$529.90 ,$560.18 ,$560.18 ,$757.00 ,$643.45 ,$403.59 ,$403.59 ,$530.66 ,$403.59 ,$314.91 , N/A ,$643.45 ,$867.72 ,$211.96 ,$681.30 ,$757.00 ,$403.59 ,$492.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000178,81377,HC HLA CLASS 2 TYPE 1 AG EQV LR-90,310,1 ,$902.00 ,$586.30 ,$94.74 ,$902.00 ,$586.30 ,$94.74 ,$252.56 ,$456.41 ,$94.74 ,$518.65 ,$94.74 ,$456.32 ,$94.74 ,$180.01 ,$739.64 ,$236.85 ,$94.74 ,$766.70 ,$811.80 ,$94.74 ,$676.50 ,$631.40 ,$667.48 ,$667.48 ,$236.85 ,$766.70 ,$94.74 ,$94.74 ,$632.30 ,$94.74 ,$375.23 , N/A ,$766.70 ,$203.69 ,$252.56 ,$811.80 ,$189.48 ,$94.74 ,$586.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000180,81383,HC HLA 2 TYPE 1 ALLELE HIGH RESOLUTION -90,310,1 ,$902.00 ,$586.30 ,$109.13 ,$902.00 ,$586.30 ,$109.13 ,$252.56 ,$456.41 ,$109.13 ,$518.65 ,$109.13 ,$456.32 ,$109.13 ,$207.35 ,$739.64 ,$272.83 ,$109.13 ,$766.70 ,$811.80 ,$109.13 ,$676.50 ,$631.40 ,$667.48 ,$667.48 ,$272.83 ,$766.70 ,$109.13 ,$109.13 ,$632.30 ,$109.13 ,$375.23 , N/A ,$766.70 ,$234.63 ,$252.56 ,$811.80 ,$218.26 ,$109.13 ,$586.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000181,81400,HC MOLECULAR PATH PROC LEVEL 1-90,310,1 ,$494.00 ,$321.10 ,$63.96 ,$494.00 ,$321.10 ,$63.96 ,$138.32 ,$249.96 ,$63.96 ,$284.05 ,$63.96 ,$249.91 ,$63.96 ,$121.52 ,$405.08 ,$159.90 ,$63.96 ,$419.90 ,$444.60 ,$63.96 ,$370.50 ,$345.80 ,$365.56 ,$365.56 ,$159.90 ,$419.90 ,$63.96 ,$63.96 ,$346.29 ,$63.96 ,$205.50 , N/A ,$419.90 ,$137.51 ,$138.32 ,$444.60 ,$127.92 ,$63.96 ,$321.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000183,81401,HC MOLECULAR PATH PROC LEVEL 2-90,310,1 ,$867.00 ,$563.55 ,$242.76 ,$867.00 ,$563.55 , N/A ,$242.76 ,$438.70 , N/A ,$498.53 , N/A ,$438.62 , N/A ,$390.15 ,$710.94 ,$606.90 , N/A ,$736.95 ,$780.30 , N/A ,$650.25 ,$606.90 ,$641.58 ,$641.58 , N/A ,$736.95 , N/A , N/A ,$607.77 , N/A ,$360.67 , N/A ,$736.95 ,$520.20 ,$242.76 ,$780.30 ,$274.00 , N/A ,$563.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000184,81403,HC MOLECULAR PATH PROC LEVEL 4-90,310,1 ,"$1,125.00 ",$731.25 ,$315.00 ,"$1,125.00 ",$731.25 , N/A ,$315.00 ,$569.25 , N/A ,$646.88 , N/A ,$569.14 , N/A ,$506.25 ,$922.50 ,$787.50 , N/A ,$956.25 ,"$1,012.50 ", N/A ,$843.75 ,$787.50 ,$832.50 ,$832.50 , N/A ,$956.25 , N/A , N/A ,$788.63 , N/A ,$468.00 , N/A ,$956.25 ,$675.00 ,$315.00 ,"$1,012.50 ",$370.40 , N/A ,$731.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31000205,81219,HC CALR GENE ANALYSIS EXON 9-90,310,1 ,$333.00 ,$216.45 ,$93.24 ,$333.00 ,$216.45 ,$121.63 ,$93.24 ,$168.50 ,$121.63 ,$191.48 ,$121.63 ,$168.46 ,$121.63 ,$231.10 ,$273.06 ,$304.08 ,$121.63 ,$283.05 ,$299.70 ,$121.63 ,$249.75 ,$233.10 ,$246.42 ,$246.42 ,$304.08 ,$283.05 ,$121.63 ,$121.63 ,$233.43 ,$121.63 ,$138.53 , N/A ,$283.05 ,$261.50 ,$93.24 ,$299.70 ,$243.26 ,$121.63 ,$216.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100244,88184,HC FLOW CYTO 1ST MARKER-90,311,1 ,$83.00 ,$53.95 ,$23.24 ,$717.84 ,$53.95 ,$287.13 ,$23.24 ,$42.00 ,$287.13 ,$47.73 ,$83.00 ,$41.99 ,$83.00 ,$83.00 ,$68.06 ,$717.84 ,$287.13 ,$70.55 ,$74.70 ,$287.13 ,$62.25 ,$58.10 ,$61.42 ,$61.42 ,$83.00 ,$70.55 ,$287.13 ,$287.13 ,$58.18 ,$287.13 ,$34.53 , N/A ,$70.55 ,$617.34 ,$23.24 ,$74.70 ,$83.00 ,$287.13 ,$53.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100251,88230,HC TISSUE CULT NONNEO LYMPHOCYTE-90,311,1 ,"$1,638.00 ","$1,064.70 ",$116.49 ,"$1,638.00 ","$1,064.70 ",$116.49 ,$458.64 ,$828.83 ,$116.49 ,$941.85 ,$116.49 ,$828.66 ,$116.49 ,$221.33 ,"$1,343.16 ",$291.23 ,$116.49 ,"$1,392.30 ","$1,474.20 ",$116.49 ,"$1,228.50 ","$1,146.60 ","$1,212.12 ","$1,212.12 ",$291.23 ,"$1,392.30 ",$116.49 ,$116.49 ,"$1,148.24 ",$116.49 ,$681.41 , N/A ,"$1,392.30 ",$250.45 ,$458.64 ,"$1,474.20 ",$232.98 ,$116.49 ,"$1,064.70 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100257,88262,HC CHROM COUNT 15-20/2-90,311,1 ,$642.00 ,$417.30 ,$125.49 ,$642.00 ,$417.30 ,$125.49 ,$179.76 ,$324.85 ,$125.49 ,$369.15 ,$125.49 ,$324.79 ,$125.49 ,$238.43 ,$526.44 ,$313.73 ,$125.49 ,$545.70 ,$577.80 ,$125.49 ,$481.50 ,$449.40 ,$475.08 ,$475.08 ,$313.73 ,$545.70 ,$125.49 ,$125.49 ,$450.04 ,$125.49 ,$267.07 , N/A ,$545.70 ,$269.80 ,$179.76 ,$577.80 ,$250.98 ,$125.49 ,$417.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100274,88289,HC CHROM ADDL HIGH RES-90,311,1 ,$138.00 ,$89.70 ,$34.43 ,$138.00 ,$89.70 ,$34.43 ,$38.64 ,$69.83 ,$34.43 ,$79.35 ,$34.43 ,$69.81 ,$34.43 ,$65.42 ,$113.16 ,$86.08 ,$34.43 ,$117.30 ,$124.20 ,$34.43 ,$103.50 ,$96.60 ,$102.12 ,$102.12 ,$86.08 ,$117.30 ,$34.43 ,$34.43 ,$96.74 ,$34.43 ,$57.41 , N/A ,$117.30 ,$74.02 ,$38.64 ,$124.20 ,$68.86 ,$34.43 ,$89.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100299,88104,HC CYTOPATH FLD SMEAR,311,1 ,$146.00 ,$94.90 ,$33.37 ,$146.00 ,$94.90 ,$33.37 ,$40.88 ,$73.88 ,$33.37 ,$83.95 ,$33.37 ,$73.86 ,$33.37 ,$63.41 ,$119.72 ,$83.43 ,$33.37 ,$124.10 ,$131.40 ,$33.37 ,$109.50 ,$102.20 ,$108.04 ,$108.04 ,$83.43 ,$124.10 ,$33.37 ,$33.37 ,$102.35 ,$33.37 ,$60.74 , N/A ,$124.10 ,$71.75 ,$40.88 ,$131.40 ,$67.68 ,$33.37 ,$94.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100304,88173,HC FINE NEEDLE INTERP,311,1 ,$218.00 ,$141.70 ,$48.99 ,$218.00 ,$141.70 ,$48.99 ,$61.04 ,$110.31 ,$48.99 ,$125.35 ,$48.99 ,$110.29 ,$48.99 ,$93.08 ,$178.76 ,$122.48 ,$48.99 ,$185.30 ,$196.20 ,$48.99 ,$163.50 ,$152.60 ,$161.32 ,$161.32 ,$122.48 ,$185.30 ,$48.99 ,$48.99 ,$152.82 ,$48.99 ,$90.69 , N/A ,$185.30 ,$105.33 ,$61.04 ,$196.20 ,$99.52 ,$48.99 ,$141.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100310,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST-90,311,1 ,$400.00 ,$260.00 ,$112.00 ,$717.84 ,$260.00 ,$287.13 ,$112.00 ,$202.40 ,$287.13 ,$230.00 ,$287.13 ,$202.36 ,$287.13 ,$400.00 ,$328.00 ,$717.84 ,$287.13 ,$340.00 ,$360.00 ,$287.13 ,$300.00 ,$280.00 ,$296.00 ,$296.00 ,$400.00 ,$340.00 ,$287.13 ,$287.13 ,$280.40 ,$287.13 ,$166.40 , N/A ,$340.00 ,$617.34 ,$112.00 ,$360.00 ,$400.00 ,$287.13 ,$260.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31100319,88104,HC CYTOPATH FLD SMEAR-90,311,1 ,$146.00 ,$94.90 ,$33.37 ,$146.00 ,$94.90 ,$33.37 ,$40.88 ,$73.88 ,$33.37 ,$83.95 ,$33.37 ,$73.86 ,$33.37 ,$63.41 ,$119.72 ,$83.43 ,$33.37 ,$124.10 ,$131.40 ,$33.37 ,$109.50 ,$102.20 ,$108.04 ,$108.04 ,$83.43 ,$124.10 ,$33.37 ,$33.37 ,$102.35 ,$33.37 ,$60.74 , N/A ,$124.10 ,$71.75 ,$40.88 ,$131.40 ,$67.68 ,$33.37 ,$94.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200296,88311,HC DECALCIFICATION,312,1 ,$71.00 ,$46.15 ,$17.44 ,$71.00 ,$46.15 , N/A ,$19.88 ,$35.93 , N/A ,$40.83 , N/A ,$35.92 , N/A , N/A ,$58.22 , N/A , N/A ,$60.35 ,$63.90 , N/A ,$53.25 ,$49.70 ,$52.54 ,$52.54 , N/A ,$60.35 , N/A , N/A ,$49.77 , N/A ,$29.54 , N/A ,$60.35 , N/A ,$19.88 ,$63.90 ,$17.44 , N/A ,$46.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200297,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$96.00 ,$62.40 ,$24.36 ,$96.00 ,$62.40 ,$24.36 ,$26.88 ,$48.58 ,$24.36 ,$55.20 ,$24.36 ,$48.57 ,$24.36 ,$46.27 ,$78.72 ,$60.89 ,$24.36 ,$81.60 ,$86.40 ,$24.36 ,$72.00 ,$67.20 ,$71.04 ,$71.04 ,$60.89 ,$81.60 ,$24.36 ,$24.36 ,$67.30 ,$24.36 ,$39.94 , N/A ,$81.60 ,$52.36 ,$26.88 ,$86.40 ,$49.34 ,$24.36 ,$62.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200298,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$289.00 ,$187.85 ,$48.99 ,$289.00 ,$187.85 ,$48.99 ,$80.92 ,$146.23 ,$48.99 ,$166.18 ,$48.99 ,$146.21 ,$48.99 ,$93.08 ,$236.98 ,$122.48 ,$48.99 ,$245.65 ,$260.10 ,$48.99 ,$216.75 ,$202.30 ,$213.86 ,$213.86 ,$122.48 ,$245.65 ,$48.99 ,$48.99 ,$202.59 ,$48.99 ,$120.22 , N/A ,$245.65 ,$105.33 ,$80.92 ,$260.10 ,$99.52 ,$48.99 ,$187.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200299,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$358.00 ,$232.70 ,$48.99 ,$358.00 ,$232.70 ,$48.99 ,$100.24 ,$181.15 ,$48.99 ,$205.85 ,$48.99 ,$181.11 ,$48.99 ,$93.08 ,$293.56 ,$122.48 ,$48.99 ,$304.30 ,$322.20 ,$48.99 ,$268.50 ,$250.60 ,$264.92 ,$264.92 ,$122.48 ,$304.30 ,$48.99 ,$48.99 ,$250.96 ,$48.99 ,$148.93 , N/A ,$304.30 ,$105.33 ,$100.24 ,$322.20 ,$99.52 ,$48.99 ,$232.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200300,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,$762.00 ,$495.30 ,$213.36 ,$762.00 ,$495.30 ,$287.13 ,$213.36 ,$385.57 ,$287.13 ,$438.15 ,$287.13 ,$385.50 ,$287.13 ,$545.56 ,$624.84 ,$717.84 ,$287.13 ,$647.70 ,$685.80 ,$287.13 ,$571.50 ,$533.40 ,$563.88 ,$563.88 ,$717.84 ,$647.70 ,$287.13 ,$287.13 ,$534.16 ,$287.13 ,$316.99 , N/A ,$647.70 ,$617.34 ,$213.36 ,$685.80 ,$582.52 ,$287.13 ,$495.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200301,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,$325.00 ,$211.25 ,$91.00 ,"$1,615.20 ",$211.25 ,$646.08 ,$91.00 ,$164.45 ,$646.08 ,$186.88 ,$325.00 ,$164.42 ,$325.00 ,$325.00 ,$266.50 ,"$1,615.20 ",$646.08 ,$276.25 ,$292.50 ,$646.08 ,$243.75 ,$227.50 ,$240.50 ,$240.50 ,$325.00 ,$276.25 ,$646.08 ,$646.08 ,$227.83 ,$646.08 ,$135.20 , N/A ,$276.25 ,"$1,389.07 ",$91.00 ,$292.50 ,$325.00 ,$646.08 ,$211.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200302,88300,HC GROSS ONLY LEVEL I,312,1 ,$75.00 ,$48.75 ,$21.00 ,$75.00 ,$48.75 ,$24.36 ,$21.00 ,$37.95 ,$24.36 ,$43.13 ,$24.36 ,$37.94 ,$24.36 ,$46.27 ,$61.50 ,$60.89 ,$24.36 ,$63.75 ,$67.50 ,$24.36 ,$56.25 ,$52.50 ,$55.50 ,$55.50 ,$60.89 ,$63.75 ,$24.36 ,$24.36 ,$52.58 ,$24.36 ,$31.20 , N/A ,$63.75 ,$52.36 ,$21.00 ,$67.50 ,$49.34 ,$24.36 ,$48.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200303,88312,HC SPECIAL STAIN I,312,1 ,$225.00 ,$146.25 ,$48.99 ,$225.00 ,$146.25 ,$48.99 ,$63.00 ,$113.85 ,$48.99 ,$129.38 ,$48.99 ,$113.83 ,$48.99 ,$93.08 ,$184.50 ,$122.48 ,$48.99 ,$191.25 ,$202.50 ,$48.99 ,$168.75 ,$157.50 ,$166.50 ,$166.50 ,$122.48 ,$191.25 ,$48.99 ,$48.99 ,$157.73 ,$48.99 ,$93.60 , N/A ,$191.25 ,$105.33 ,$63.00 ,$202.50 ,$99.52 ,$48.99 ,$146.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200304,88313,HC SPECIAL STAIN II,312,1 ,$184.00 ,$119.60 ,$33.37 ,$184.00 ,$119.60 ,$33.37 ,$51.52 ,$93.10 ,$33.37 ,$105.80 ,$33.37 ,$93.09 ,$33.37 ,$63.41 ,$150.88 ,$83.43 ,$33.37 ,$156.40 ,$165.60 ,$33.37 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$83.43 ,$156.40 ,$33.37 ,$33.37 ,$128.98 ,$33.37 ,$76.54 , N/A ,$156.40 ,$71.75 ,$51.52 ,$165.60 ,$67.68 ,$33.37 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200305,88342,HC IMMUNOHISOCHEMIST EA AB REPEAT,312,1 ,$579.00 ,$376.35 ,$147.04 ,$579.00 ,$376.35 ,$147.04 ,$162.12 ,$292.97 ,$147.04 ,$332.93 ,$147.04 ,$292.92 ,$147.04 ,$279.37 ,$474.78 ,$367.59 ,$147.04 ,$492.15 ,$521.10 ,$147.04 ,$434.25 ,$405.30 ,$428.46 ,$428.46 ,$367.59 ,$492.15 ,$147.04 ,$147.04 ,$405.88 ,$147.04 ,$240.86 , N/A ,$492.15 ,$316.13 ,$162.12 ,$521.10 ,$298.32 ,$147.04 ,$376.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200307,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$290.00 ,$188.50 ,$81.20 ,$290.00 ,$188.50 , N/A ,$81.20 ,$146.74 , N/A ,$166.75 , N/A ,$146.71 , N/A , N/A ,$237.80 , N/A , N/A ,$246.50 ,$261.00 , N/A ,$217.50 ,$203.00 ,$214.60 ,$214.60 , N/A ,$246.50 , N/A , N/A ,$203.29 , N/A ,$120.64 , N/A ,$246.50 , N/A ,$81.20 ,$261.00 ,$130.50 , N/A ,$188.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),31200315,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$373.00 ,$242.45 ,$104.44 ,$373.00 ,$242.45 ,$147.04 ,$104.44 ,$188.74 ,$147.04 ,$214.48 ,$147.04 ,$188.70 ,$147.04 ,$279.37 ,$305.86 ,$367.59 ,$147.04 ,$317.05 ,$335.70 ,$147.04 ,$279.75 ,$261.10 ,$276.02 ,$276.02 ,$367.59 ,$317.05 ,$147.04 ,$147.04 ,$261.47 ,$147.04 ,$155.17 , N/A ,$317.05 ,$316.13 ,$104.44 ,$335.70 ,$298.32 ,$147.04 ,$242.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$321.00 ,$208.65 ,$89.88 ,$321.00 ,$208.65 , N/A ,$89.88 ,$162.43 , N/A ,$184.58 , N/A ,$162.39 , N/A , N/A ,$263.22 , N/A , N/A ,$272.85 ,$288.90 , N/A ,$240.75 ,$224.70 ,$237.54 ,$237.54 , N/A ,$272.85 , N/A , N/A ,$225.02 , N/A ,$133.54 , N/A ,$272.85 , N/A ,$89.88 ,$288.90 ,$321.00 , N/A ,$208.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$739.00 ,$480.35 ,$206.92 ,$739.00 ,$480.35 , N/A ,$206.92 ,$373.93 , N/A ,$424.93 , N/A ,$373.86 , N/A , N/A ,$605.98 , N/A , N/A ,$628.15 ,$665.10 , N/A ,$554.25 ,$517.30 ,$546.86 ,$546.86 , N/A ,$628.15 , N/A , N/A ,$518.04 , N/A ,$307.42 , N/A ,$628.15 , N/A ,$206.92 ,$665.10 ,$475.00 , N/A ,$480.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$321.00 ,$208.65 ,$89.88 ,$321.00 ,$208.65 , N/A ,$89.88 ,$162.43 , N/A ,$184.58 , N/A ,$162.39 , N/A , N/A ,$263.22 , N/A , N/A ,$272.85 ,$288.90 , N/A ,$240.75 ,$224.70 ,$237.54 ,$237.54 , N/A ,$272.85 , N/A , N/A ,$225.02 , N/A ,$133.54 , N/A ,$272.85 , N/A ,$89.88 ,$288.90 ,$321.00 , N/A ,$208.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$321.00 ,$208.65 ,$89.88 ,$321.00 ,$208.65 , N/A ,$89.88 ,$162.43 , N/A ,$184.58 , N/A ,$162.39 , N/A , N/A ,$263.22 , N/A , N/A ,$272.85 ,$288.90 , N/A ,$240.75 ,$224.70 ,$237.54 ,$237.54 , N/A ,$272.85 , N/A , N/A ,$225.02 , N/A ,$133.54 , N/A ,$272.85 , N/A ,$89.88 ,$288.90 ,$321.00 , N/A ,$208.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$710.00 ,$461.50 ,$198.80 ,$710.00 ,$461.50 , N/A ,$198.80 ,$359.26 , N/A ,$408.25 , N/A ,$359.19 , N/A , N/A ,$582.20 , N/A , N/A ,$603.50 ,$639.00 , N/A ,$532.50 ,$497.00 ,$525.40 ,$525.40 , N/A ,$603.50 , N/A , N/A ,$497.71 , N/A ,$295.36 , N/A ,$603.50 , N/A ,$198.80 ,$639.00 ,$475.00 , N/A ,$461.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,"$1,007.00 ",$654.55 ,$281.96 ,"$1,007.00 ",$654.55 , N/A ,$281.96 ,$509.54 , N/A ,$579.03 , N/A ,$509.44 , N/A , N/A ,$825.74 , N/A , N/A ,$855.95 ,$906.30 , N/A ,$755.25 ,$704.90 ,$745.18 ,$745.18 , N/A ,$855.95 , N/A , N/A ,$705.91 , N/A ,$418.91 , N/A ,$855.95 , N/A ,$281.96 ,$906.30 ,$475.00 , N/A ,$654.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,874.00 ","$1,218.10 ",$475.00 ,"$3,465.89 ","$1,218.10 ","$1,386.35 ",$524.72 ,$948.24 ,"$1,386.35 ","$1,077.55 ","$1,386.35 ",$948.06 ,"$1,386.35 ","$1,874.00 ","$1,536.68 ","$3,465.89 ","$1,386.35 ","$1,592.90 ","$1,686.60 ","$1,386.35 ","$1,405.50 ","$1,311.80 ","$1,386.76 ","$1,386.76 ","$1,874.00 ","$1,592.90 ","$1,386.35 ","$1,386.35 ","$1,313.67 ","$1,386.35 ",$779.58 , N/A ,"$1,592.90 ","$2,980.66 ",$524.72 ,"$1,686.60 ",$475.00 ,"$1,386.35 ","$1,218.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000027,36002,HC INJ PSEUDOANEURYSM (THROMBIN),320,1 ,"$1,542.00 ","$1,002.30 ",$431.76 ,"$1,542.00 ","$1,002.30 ",$532.90 ,$431.76 ,$780.25 ,$532.90 ,$886.65 ,$532.90 ,$780.10 ,$532.90 ,"$1,012.50 ","$1,264.44 ","$1,332.24 ",$532.90 ,"$1,310.70 ","$1,387.80 ",$532.90 ,"$1,156.50 ","$1,079.40 ","$1,141.08 ","$1,141.08 ","$1,332.24 ","$1,310.70 ",$532.90 ,$532.90 ,"$1,080.94 ",$532.90 ,$641.47 , N/A ,"$1,310.70 ","$1,145.72 ",$431.76 ,"$1,387.80 ",$475.00 ,$532.90 ,"$1,002.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$443.00 ,$287.95 ,$124.04 ,$668.92 ,$287.95 ,$267.57 ,$124.04 ,$224.16 ,$267.57 ,$254.73 ,$267.57 ,$224.11 ,$267.57 ,$443.00 ,$363.26 ,$668.92 ,$267.57 ,$376.55 ,$398.70 ,$267.57 ,$332.25 ,$310.10 ,$327.82 ,$327.82 ,$443.00 ,$376.55 ,$267.57 ,$267.57 ,$310.54 ,$267.57 ,$184.29 , N/A ,$376.55 ,$575.27 ,$124.04 ,$398.70 ,$443.00 ,$267.57 ,$287.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$655.00 ,$425.75 ,$183.40 ,$655.00 ,$425.75 ,$226.85 ,$183.40 ,$331.43 ,$226.85 ,$376.63 ,$226.85 ,$331.36 ,$226.85 ,$431.02 ,$537.10 ,$567.13 ,$226.85 ,$556.75 ,$589.50 ,$226.85 ,$491.25 ,$458.50 ,$484.70 ,$484.70 ,$567.13 ,$556.75 ,$226.85 ,$226.85 ,$459.16 ,$226.85 ,$272.48 , N/A ,$556.75 ,$487.73 ,$183.40 ,$589.50 ,$475.00 ,$226.85 ,$425.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000085,51600,HC INJ CYSTOGRAM,320,1 ,"$1,057.00 ",$687.05 ,$295.96 ,"$1,057.00 ",$687.05 , N/A ,$295.96 ,$534.84 , N/A ,$607.78 , N/A ,$534.74 , N/A , N/A ,$866.74 , N/A , N/A ,$898.45 ,$951.30 , N/A ,$792.75 ,$739.90 ,$782.18 ,$782.18 , N/A ,$898.45 , N/A , N/A ,$740.96 , N/A ,$439.71 , N/A ,$898.45 , N/A ,$295.96 ,$951.30 ,$475.00 , N/A ,$687.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000086,51610,HC INJ URETHROCYSTOGRAM RETRO,320,1 ,"$1,431.00 ",$930.15 ,$400.68 ,"$1,431.00 ",$930.15 , N/A ,$400.68 ,$724.09 , N/A ,$822.83 , N/A ,$723.94 , N/A , N/A ,"$1,173.42 ", N/A , N/A ,"$1,216.35 ","$1,287.90 ", N/A ,"$1,073.25 ","$1,001.70 ","$1,058.94 ","$1,058.94 ", N/A ,"$1,216.35 ", N/A , N/A ,"$1,003.13 ", N/A ,$595.30 , N/A ,"$1,216.35 ", N/A ,$400.68 ,"$1,287.90 ",$475.00 , N/A ,$930.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$321.00 ,$208.65 ,$89.88 ,$321.00 ,$208.65 , N/A ,$89.88 ,$162.43 , N/A ,$184.58 , N/A ,$162.39 , N/A , N/A ,$263.22 , N/A , N/A ,$272.85 ,$288.90 , N/A ,$240.75 ,$224.70 ,$237.54 ,$237.54 , N/A ,$272.85 , N/A , N/A ,$225.02 , N/A ,$133.54 , N/A ,$272.85 , N/A ,$89.88 ,$288.90 ,$321.00 , N/A ,$208.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$448.00 ,$291.20 ,$79.75 ,$448.00 ,$291.20 ,$79.75 ,$125.44 ,$226.69 ,$79.75 ,$257.60 ,$79.75 ,$226.64 ,$79.75 ,$151.52 ,$367.36 ,$199.36 ,$79.75 ,$380.80 ,$403.20 ,$79.75 ,$336.00 ,$313.60 ,$331.52 ,$331.52 ,$199.36 ,$380.80 ,$79.75 ,$79.75 ,$314.05 ,$79.75 ,$186.37 , N/A ,$380.80 ,$171.45 ,$125.44 ,$403.20 ,$448.00 ,$79.75 ,$291.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$427.00 ,$277.55 ,$107.33 ,$427.00 ,$277.55 ,$107.33 ,$119.56 ,$216.06 ,$107.33 ,$245.53 ,$107.33 ,$216.02 ,$107.33 ,$203.93 ,$350.14 ,$268.33 ,$107.33 ,$362.95 ,$384.30 ,$107.33 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$268.33 ,$362.95 ,$107.33 ,$107.33 ,$299.33 ,$107.33 ,$177.63 , N/A ,$362.95 ,$230.77 ,$119.56 ,$384.30 ,$427.00 ,$107.33 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$537.00 ,$349.05 ,$107.33 ,$537.00 ,$349.05 ,$107.33 ,$150.36 ,$271.72 ,$107.33 ,$308.78 ,$107.33 ,$271.67 ,$107.33 ,$203.93 ,$440.34 ,$268.33 ,$107.33 ,$456.45 ,$483.30 ,$107.33 ,$402.75 ,$375.90 ,$397.38 ,$397.38 ,$268.33 ,$456.45 ,$107.33 ,$107.33 ,$376.44 ,$107.33 ,$223.39 , N/A ,$456.45 ,$230.77 ,$150.36 ,$483.30 ,$475.00 ,$107.33 ,$349.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$537.00 ,$349.05 ,$79.75 ,$537.00 ,$349.05 ,$79.75 ,$150.36 ,$271.72 ,$79.75 ,$308.78 ,$79.75 ,$271.67 ,$79.75 ,$151.52 ,$440.34 ,$199.36 ,$79.75 ,$456.45 ,$483.30 ,$79.75 ,$402.75 ,$375.90 ,$397.38 ,$397.38 ,$199.36 ,$456.45 ,$79.75 ,$79.75 ,$376.44 ,$79.75 ,$223.39 , N/A ,$456.45 ,$171.45 ,$150.36 ,$483.30 ,$475.00 ,$79.75 ,$349.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$460.00 ,$299.00 ,$107.33 ,$460.00 ,$299.00 ,$107.33 ,$128.80 ,$232.76 ,$107.33 ,$264.50 ,$107.33 ,$232.71 ,$107.33 ,$203.93 ,$377.20 ,$268.33 ,$107.33 ,$391.00 ,$414.00 ,$107.33 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$268.33 ,$391.00 ,$107.33 ,$107.33 ,$322.46 ,$107.33 ,$191.36 , N/A ,$391.00 ,$230.77 ,$128.80 ,$414.00 ,$460.00 ,$107.33 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$717.00 ,$466.05 ,$107.33 ,$717.00 ,$466.05 ,$107.33 ,$200.76 ,$362.80 ,$107.33 ,$412.28 ,$107.33 ,$362.73 ,$107.33 ,$203.93 ,$587.94 ,$268.33 ,$107.33 ,$609.45 ,$645.30 ,$107.33 ,$537.75 ,$501.90 ,$530.58 ,$530.58 ,$268.33 ,$609.45 ,$107.33 ,$107.33 ,$502.62 ,$107.33 ,$298.27 , N/A ,$609.45 ,$230.77 ,$200.76 ,$645.30 ,$475.00 ,$107.33 ,$466.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$448.00 ,$291.20 ,$79.75 ,$448.00 ,$291.20 ,$79.75 ,$125.44 ,$226.69 ,$79.75 ,$257.60 ,$79.75 ,$226.64 ,$79.75 ,$151.52 ,$367.36 ,$199.36 ,$79.75 ,$380.80 ,$403.20 ,$79.75 ,$336.00 ,$313.60 ,$331.52 ,$331.52 ,$199.36 ,$380.80 ,$79.75 ,$79.75 ,$314.05 ,$79.75 ,$186.37 , N/A ,$380.80 ,$171.45 ,$125.44 ,$403.20 ,$448.00 ,$79.75 ,$291.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000121,71045,HC XR CHEST 1V,320,1 ,$412.00 ,$267.80 ,$79.75 ,$412.00 ,$267.80 ,$79.75 ,$115.36 ,$208.47 ,$79.75 ,$236.90 ,$79.75 ,$208.43 ,$79.75 ,$151.52 ,$337.84 ,$199.36 ,$79.75 ,$350.20 ,$370.80 ,$79.75 ,$309.00 ,$288.40 ,$304.88 ,$304.88 ,$199.36 ,$350.20 ,$79.75 ,$79.75 ,$288.81 ,$79.75 ,$171.39 , N/A ,$350.20 ,$171.45 ,$115.36 ,$370.80 ,$412.00 ,$79.75 ,$267.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000127,71046,HC XR CHEST 2V,320,1 ,$466.00 ,$302.90 ,$79.75 ,$466.00 ,$302.90 ,$79.75 ,$130.48 ,$235.80 ,$79.75 ,$267.95 ,$79.75 ,$235.75 ,$79.75 ,$151.52 ,$382.12 ,$199.36 ,$79.75 ,$396.10 ,$419.40 ,$79.75 ,$349.50 ,$326.20 ,$344.84 ,$344.84 ,$199.36 ,$396.10 ,$79.75 ,$79.75 ,$326.67 ,$79.75 ,$193.86 , N/A ,$396.10 ,$171.45 ,$130.48 ,$419.40 ,$466.00 ,$79.75 ,$302.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000137,71100,HC XR RIBS 2V UNI,320,1 ,$460.00 ,$299.00 ,$79.75 ,$460.00 ,$299.00 ,$79.75 ,$128.80 ,$232.76 ,$79.75 ,$264.50 ,$79.75 ,$232.71 ,$79.75 ,$151.52 ,$377.20 ,$199.36 ,$79.75 ,$391.00 ,$414.00 ,$79.75 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$199.36 ,$391.00 ,$79.75 ,$79.75 ,$322.46 ,$79.75 ,$191.36 , N/A ,$391.00 ,$171.45 ,$128.80 ,$414.00 ,$460.00 ,$79.75 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$537.00 ,$349.05 ,$107.33 ,$537.00 ,$349.05 ,$107.33 ,$150.36 ,$271.72 ,$107.33 ,$308.78 ,$107.33 ,$271.67 ,$107.33 ,$203.93 ,$440.34 ,$268.33 ,$107.33 ,$456.45 ,$483.30 ,$107.33 ,$402.75 ,$375.90 ,$397.38 ,$397.38 ,$268.33 ,$456.45 ,$107.33 ,$107.33 ,$376.44 ,$107.33 ,$223.39 , N/A ,$456.45 ,$230.77 ,$150.36 ,$483.30 ,$475.00 ,$107.33 ,$349.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$576.00 ,$374.40 ,$107.33 ,$576.00 ,$374.40 ,$107.33 ,$161.28 ,$291.46 ,$107.33 ,$331.20 ,$107.33 ,$291.40 ,$107.33 ,$203.93 ,$472.32 ,$268.33 ,$107.33 ,$489.60 ,$518.40 ,$107.33 ,$432.00 ,$403.20 ,$426.24 ,$426.24 ,$268.33 ,$489.60 ,$107.33 ,$107.33 ,$403.78 ,$107.33 ,$239.62 , N/A ,$489.60 ,$230.77 ,$161.28 ,$518.40 ,$475.00 ,$107.33 ,$374.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$701.00 ,$455.65 ,$107.33 ,$701.00 ,$455.65 ,$107.33 ,$196.28 ,$354.71 ,$107.33 ,$403.08 ,$107.33 ,$354.64 ,$107.33 ,$203.93 ,$574.82 ,$268.33 ,$107.33 ,$595.85 ,$630.90 ,$107.33 ,$525.75 ,$490.70 ,$518.74 ,$518.74 ,$268.33 ,$595.85 ,$107.33 ,$107.33 ,$491.40 ,$107.33 ,$291.62 , N/A ,$595.85 ,$230.77 ,$196.28 ,$630.90 ,$475.00 ,$107.33 ,$455.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000141,71120,HC XR STERNUM 2+V,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$2,336.00 ","$1,518.40 ",$107.33 ,"$2,336.00 ","$1,518.40 ",$107.33 ,$654.08 ,"$1,182.02 ",$107.33 ,"$1,343.20 ",$107.33 ,"$1,181.78 ",$107.33 ,$203.93 ,"$1,915.52 ",$268.33 ,$107.33 ,"$1,985.60 ","$2,102.40 ",$107.33 ,"$1,752.00 ","$1,635.20 ","$1,728.64 ","$1,728.64 ",$268.33 ,"$1,985.60 ",$107.33 ,$107.33 ,"$1,637.54 ",$107.33 ,$971.78 , N/A ,"$1,985.60 ",$230.77 ,$654.08 ,"$2,102.40 ",$775.00 ,$107.33 ,"$1,518.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,825.00 ","$1,836.25 ",$176.10 ,"$2,825.00 ","$1,836.25 ",$176.10 ,$791.00 ,"$1,429.45 ",$176.10 ,"$1,624.38 ",$176.10 ,"$1,429.17 ",$176.10 ,$334.60 ,"$2,316.50 ",$440.26 ,$176.10 ,"$2,401.25 ","$2,542.50 ",$176.10 ,"$2,118.75 ","$1,977.50 ","$2,090.50 ","$2,090.50 ",$440.26 ,"$2,401.25 ",$176.10 ,$176.10 ,"$1,980.33 ",$176.10 ,"$1,175.20 ", N/A ,"$2,401.25 ",$378.62 ,$791.00 ,"$2,542.50 ",$775.00 ,$176.10 ,"$1,836.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$3,173.00 ","$2,062.45 ",$176.10 ,"$3,173.00 ","$2,062.45 ",$176.10 ,$888.44 ,"$1,605.54 ",$176.10 ,"$1,824.48 ",$176.10 ,"$1,605.22 ",$176.10 ,$334.60 ,"$2,601.86 ",$440.26 ,$176.10 ,"$2,697.05 ","$2,855.70 ",$176.10 ,"$2,379.75 ","$2,221.10 ","$2,348.02 ","$2,348.02 ",$440.26 ,"$2,697.05 ",$176.10 ,$176.10 ,"$2,224.27 ",$176.10 ,"$1,319.97 ", N/A ,"$2,697.05 ",$378.62 ,$888.44 ,"$2,855.70 ",$775.00 ,$176.10 ,"$2,062.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$3,093.00 ","$2,010.45 ",$176.10 ,"$3,093.00 ","$2,010.45 ",$176.10 ,$866.04 ,"$1,565.06 ",$176.10 ,"$1,778.48 ",$176.10 ,"$1,564.75 ",$176.10 ,$334.60 ,"$2,536.26 ",$440.26 ,$176.10 ,"$2,629.05 ","$2,783.70 ",$176.10 ,"$2,319.75 ","$2,165.10 ","$2,288.82 ","$2,288.82 ",$440.26 ,"$2,629.05 ",$176.10 ,$176.10 ,"$2,168.19 ",$176.10 ,"$1,286.69 ", N/A ,"$2,629.05 ",$378.62 ,$866.04 ,"$2,783.70 ",$775.00 ,$176.10 ,"$2,010.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,047.00 ","$1,980.55 ",$226.85 ,"$3,047.00 ","$1,980.55 ",$226.85 ,$853.16 ,"$1,541.78 ",$226.85 ,"$1,752.03 ",$226.85 ,"$1,541.48 ",$226.85 ,$431.02 ,"$2,498.54 ",$567.13 ,$226.85 ,"$2,589.95 ","$2,742.30 ",$226.85 ,"$2,285.25 ","$2,132.90 ","$2,254.78 ","$2,254.78 ",$567.13 ,"$2,589.95 ",$226.85 ,$226.85 ,"$2,135.95 ",$226.85 ,"$1,267.55 ", N/A ,"$2,589.95 ",$487.73 ,$853.16 ,"$2,742.30 ","$1,400.00 ",$226.85 ,"$1,980.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,521.00 ","$2,288.65 ",$705.33 ,"$3,521.00 ","$2,288.65 ",$705.33 ,$985.88 ,"$1,781.63 ",$705.33 ,"$2,024.58 ",$705.33 ,"$1,781.27 ",$705.33 ,"$1,340.13 ","$2,887.22 ","$1,763.33 ",$705.33 ,"$2,992.85 ","$3,168.90 ",$705.33 ,"$2,640.75 ","$2,464.70 ","$2,605.54 ","$2,605.54 ","$1,763.33 ","$2,992.85 ",$705.33 ,$705.33 ,"$2,468.22 ",$705.33 ,"$1,464.74 ", N/A ,"$2,992.85 ","$1,516.46 ",$985.88 ,"$3,168.90 ","$1,400.00 ",$705.33 ,"$2,288.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$4,444.00 ","$2,888.60 ",$363.05 ,"$4,444.00 ","$2,888.60 ",$363.05 ,"$1,244.32 ","$2,248.66 ",$363.05 ,"$2,555.30 ",$363.05 ,"$2,248.22 ",$363.05 ,$689.79 ,"$3,644.08 ",$907.62 ,$363.05 ,"$3,777.40 ","$3,999.60 ",$363.05 ,"$3,333.00 ","$3,110.80 ","$3,288.56 ","$3,288.56 ",$907.62 ,"$3,777.40 ",$363.05 ,$363.05 ,"$3,115.24 ",$363.05 ,"$1,848.70 ", N/A ,"$3,777.40 ",$780.55 ,"$1,244.32 ","$3,999.60 ","$1,400.00 ",$363.05 ,"$2,888.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000156,72020,HC XR C-SPINE 1V,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000161,72020,HC XR L-SPINE 1V,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$717.00 ,$466.05 ,$107.33 ,$717.00 ,$466.05 ,$107.33 ,$200.76 ,$362.80 ,$107.33 ,$412.28 ,$107.33 ,$362.73 ,$107.33 ,$203.93 ,$587.94 ,$268.33 ,$107.33 ,$609.45 ,$645.30 ,$107.33 ,$537.75 ,$501.90 ,$530.58 ,$530.58 ,$268.33 ,$609.45 ,$107.33 ,$107.33 ,$502.62 ,$107.33 ,$298.27 , N/A ,$609.45 ,$230.77 ,$200.76 ,$645.30 ,$475.00 ,$107.33 ,$466.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$717.00 ,$466.05 ,$107.33 ,$717.00 ,$466.05 ,$107.33 ,$200.76 ,$362.80 ,$107.33 ,$412.28 ,$107.33 ,$362.73 ,$107.33 ,$203.93 ,$587.94 ,$268.33 ,$107.33 ,$609.45 ,$645.30 ,$107.33 ,$537.75 ,$501.90 ,$530.58 ,$530.58 ,$268.33 ,$609.45 ,$107.33 ,$107.33 ,$502.62 ,$107.33 ,$298.27 , N/A ,$609.45 ,$230.77 ,$200.76 ,$645.30 ,$475.00 ,$107.33 ,$466.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000172,72070,HC XR T-SPINE 2V,320,1 ,$427.00 ,$277.55 ,$107.33 ,$427.00 ,$277.55 ,$107.33 ,$119.56 ,$216.06 ,$107.33 ,$245.53 ,$107.33 ,$216.02 ,$107.33 ,$203.93 ,$350.14 ,$268.33 ,$107.33 ,$362.95 ,$384.30 ,$107.33 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$268.33 ,$362.95 ,$107.33 ,$107.33 ,$299.33 ,$107.33 ,$177.63 , N/A ,$362.95 ,$230.77 ,$119.56 ,$384.30 ,$427.00 ,$107.33 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000174,72072,HC XR T-SPINE 3V,320,1 ,$460.00 ,$299.00 ,$107.33 ,$460.00 ,$299.00 ,$107.33 ,$128.80 ,$232.76 ,$107.33 ,$264.50 ,$107.33 ,$232.71 ,$107.33 ,$203.93 ,$377.20 ,$268.33 ,$107.33 ,$391.00 ,$414.00 ,$107.33 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$268.33 ,$391.00 ,$107.33 ,$107.33 ,$322.46 ,$107.33 ,$191.36 , N/A ,$391.00 ,$230.77 ,$128.80 ,$414.00 ,$460.00 ,$107.33 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$537.00 ,$349.05 ,$107.33 ,$537.00 ,$349.05 ,$107.33 ,$150.36 ,$271.72 ,$107.33 ,$308.78 ,$107.33 ,$271.67 ,$107.33 ,$203.93 ,$440.34 ,$268.33 ,$107.33 ,$456.45 ,$483.30 ,$107.33 ,$402.75 ,$375.90 ,$397.38 ,$397.38 ,$268.33 ,$456.45 ,$107.33 ,$107.33 ,$376.44 ,$107.33 ,$223.39 , N/A ,$456.45 ,$230.77 ,$150.36 ,$483.30 ,$475.00 ,$107.33 ,$349.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000181,72110,HC XR L-SPINE 4+V,320,1 ,$850.00 ,$552.50 ,$107.33 ,$850.00 ,$552.50 ,$107.33 ,$238.00 ,$430.10 ,$107.33 ,$488.75 ,$107.33 ,$430.02 ,$107.33 ,$203.93 ,$697.00 ,$268.33 ,$107.33 ,$722.50 ,$765.00 ,$107.33 ,$637.50 ,$595.00 ,$629.00 ,$629.00 ,$268.33 ,$722.50 ,$107.33 ,$107.33 ,$595.85 ,$107.33 ,$353.60 , N/A ,$722.50 ,$230.77 ,$238.00 ,$765.00 ,$475.00 ,$107.33 ,$552.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,$717.00 ,$466.05 ,$107.33 ,$717.00 ,$466.05 ,$107.33 ,$200.76 ,$362.80 ,$107.33 ,$412.28 ,$107.33 ,$362.73 ,$107.33 ,$203.93 ,$587.94 ,$268.33 ,$107.33 ,$609.45 ,$645.30 ,$107.33 ,$537.75 ,$501.90 ,$530.58 ,$530.58 ,$268.33 ,$609.45 ,$107.33 ,$107.33 ,$502.62 ,$107.33 ,$298.27 , N/A ,$609.45 ,$230.77 ,$200.76 ,$645.30 ,$475.00 ,$107.33 ,$466.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000186,72170,HC XR PELVIS 1-2V,320,1 ,$420.00 ,$273.00 ,$107.33 ,$420.00 ,$273.00 ,$107.33 ,$117.60 ,$212.52 ,$107.33 ,$241.50 ,$107.33 ,$212.48 ,$107.33 ,$203.93 ,$344.40 ,$268.33 ,$107.33 ,$357.00 ,$378.00 ,$107.33 ,$315.00 ,$294.00 ,$310.80 ,$310.80 ,$268.33 ,$357.00 ,$107.33 ,$107.33 ,$294.42 ,$107.33 ,$174.72 , N/A ,$357.00 ,$230.77 ,$117.60 ,$378.00 ,$420.00 ,$107.33 ,$273.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$409.00 ,$265.85 ,$107.33 ,$409.00 ,$265.85 ,$107.33 ,$114.52 ,$206.95 ,$107.33 ,$235.18 ,$107.33 ,$206.91 ,$107.33 ,$203.93 ,$335.38 ,$268.33 ,$107.33 ,$347.65 ,$368.10 ,$107.33 ,$306.75 ,$286.30 ,$302.66 ,$302.66 ,$268.33 ,$347.65 ,$107.33 ,$107.33 ,$286.71 ,$107.33 ,$170.14 , N/A ,$347.65 ,$230.77 ,$114.52 ,$368.10 ,$409.00 ,$107.33 ,$265.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000201,73000,HC XRAY CLAVICLE,320,1 ,$389.00 ,$252.85 ,$79.75 ,$389.00 ,$252.85 ,$79.75 ,$108.92 ,$196.83 ,$79.75 ,$223.68 ,$79.75 ,$196.80 ,$79.75 ,$151.52 ,$318.98 ,$199.36 ,$79.75 ,$330.65 ,$350.10 ,$79.75 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$199.36 ,$330.65 ,$79.75 ,$79.75 ,$272.69 ,$79.75 ,$161.82 , N/A ,$330.65 ,$171.45 ,$108.92 ,$350.10 ,$389.00 ,$79.75 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000204,73010,HC XRAY SCAPULA,320,1 ,$427.00 ,$277.55 ,$107.33 ,$427.00 ,$277.55 ,$107.33 ,$119.56 ,$216.06 ,$107.33 ,$245.53 ,$107.33 ,$216.02 ,$107.33 ,$203.93 ,$350.14 ,$268.33 ,$107.33 ,$362.95 ,$384.30 ,$107.33 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$268.33 ,$362.95 ,$107.33 ,$107.33 ,$299.33 ,$107.33 ,$177.63 , N/A ,$362.95 ,$230.77 ,$119.56 ,$384.30 ,$427.00 ,$107.33 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$389.00 ,$252.85 ,$79.75 ,$389.00 ,$252.85 ,$79.75 ,$108.92 ,$196.83 ,$79.75 ,$223.68 ,$79.75 ,$196.80 ,$79.75 ,$151.52 ,$318.98 ,$199.36 ,$79.75 ,$330.65 ,$350.10 ,$79.75 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$199.36 ,$330.65 ,$79.75 ,$79.75 ,$272.69 ,$79.75 ,$161.82 , N/A ,$330.65 ,$171.45 ,$108.92 ,$350.10 ,$389.00 ,$79.75 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$471.00 ,$306.15 ,$79.75 ,$471.00 ,$306.15 ,$79.75 ,$131.88 ,$238.33 ,$79.75 ,$270.83 ,$79.75 ,$238.28 ,$79.75 ,$151.52 ,$386.22 ,$199.36 ,$79.75 ,$400.35 ,$423.90 ,$79.75 ,$353.25 ,$329.70 ,$348.54 ,$348.54 ,$199.36 ,$400.35 ,$79.75 ,$79.75 ,$330.17 ,$79.75 ,$195.94 , N/A ,$400.35 ,$171.45 ,$131.88 ,$423.90 ,$471.00 ,$79.75 ,$306.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,257.00 ",$817.05 ,$351.96 ,"$1,257.00 ",$817.05 ,$363.05 ,$351.96 ,$636.04 ,$363.05 ,$722.78 ,$363.05 ,$635.92 ,$363.05 ,$689.79 ,"$1,030.74 ",$907.62 ,$363.05 ,"$1,068.45 ","$1,131.30 ",$363.05 ,$942.75 ,$879.90 ,$930.18 ,$930.18 ,$907.62 ,"$1,068.45 ",$363.05 ,$363.05 ,$881.16 ,$363.05 ,$522.91 , N/A ,"$1,068.45 ",$780.55 ,$351.96 ,"$1,131.30 ",$475.00 ,$363.05 ,$817.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$389.00 ,$252.85 ,$79.75 ,$389.00 ,$252.85 ,$79.75 ,$108.92 ,$196.83 ,$79.75 ,$223.68 ,$79.75 ,$196.80 ,$79.75 ,$151.52 ,$318.98 ,$199.36 ,$79.75 ,$330.65 ,$350.10 ,$79.75 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$199.36 ,$330.65 ,$79.75 ,$79.75 ,$272.69 ,$79.75 ,$161.82 , N/A ,$330.65 ,$171.45 ,$108.92 ,$350.10 ,$389.00 ,$79.75 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$246.00 ,$159.90 ,$68.88 ,$246.00 ,$159.90 ,$79.75 ,$68.88 ,$124.48 ,$79.75 ,$141.45 ,$79.75 ,$124.45 ,$79.75 ,$151.52 ,$201.72 ,$199.36 ,$79.75 ,$209.10 ,$221.40 ,$79.75 ,$184.50 ,$172.20 ,$182.04 ,$182.04 ,$199.36 ,$209.10 ,$79.75 ,$79.75 ,$172.45 ,$79.75 ,$102.34 , N/A ,$209.10 ,$171.45 ,$68.88 ,$221.40 ,$246.00 ,$79.75 ,$159.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$420.00 ,$273.00 ,$79.75 ,$420.00 ,$273.00 ,$79.75 ,$117.60 ,$212.52 ,$79.75 ,$241.50 ,$79.75 ,$212.48 ,$79.75 ,$151.52 ,$344.40 ,$199.36 ,$79.75 ,$357.00 ,$378.00 ,$79.75 ,$315.00 ,$294.00 ,$310.80 ,$310.80 ,$199.36 ,$357.00 ,$79.75 ,$79.75 ,$294.42 ,$79.75 ,$174.72 , N/A ,$357.00 ,$171.45 ,$117.60 ,$378.00 ,$420.00 ,$79.75 ,$273.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$420.00 ,$273.00 ,$79.75 ,$420.00 ,$273.00 ,$79.75 ,$117.60 ,$212.52 ,$79.75 ,$241.50 ,$79.75 ,$212.48 ,$79.75 ,$151.52 ,$344.40 ,$199.36 ,$79.75 ,$357.00 ,$378.00 ,$79.75 ,$315.00 ,$294.00 ,$310.80 ,$310.80 ,$199.36 ,$357.00 ,$79.75 ,$79.75 ,$294.42 ,$79.75 ,$174.72 , N/A ,$357.00 ,$171.45 ,$117.60 ,$378.00 ,$420.00 ,$79.75 ,$273.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$487.00 ,$316.55 ,$79.75 ,$487.00 ,$316.55 ,$79.75 ,$136.36 ,$246.42 ,$79.75 ,$280.03 ,$79.75 ,$246.37 ,$79.75 ,$151.52 ,$399.34 ,$199.36 ,$79.75 ,$413.95 ,$438.30 ,$79.75 ,$365.25 ,$340.90 ,$360.38 ,$360.38 ,$199.36 ,$413.95 ,$79.75 ,$79.75 ,$341.39 ,$79.75 ,$202.59 , N/A ,$413.95 ,$171.45 ,$136.36 ,$438.30 ,$475.00 ,$79.75 ,$316.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,257.00 ",$817.05 ,$351.96 ,"$1,257.00 ",$817.05 ,$363.05 ,$351.96 ,$636.04 ,$363.05 ,$722.78 ,$363.05 ,$635.92 ,$363.05 ,$689.79 ,"$1,030.74 ",$907.62 ,$363.05 ,"$1,068.45 ","$1,131.30 ",$363.05 ,$942.75 ,$879.90 ,$930.18 ,$930.18 ,$907.62 ,"$1,068.45 ",$363.05 ,$363.05 ,$881.16 ,$363.05 ,$522.91 , N/A ,"$1,068.45 ",$780.55 ,$351.96 ,"$1,131.30 ",$475.00 ,$363.05 ,$817.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$420.00 ,$273.00 ,$107.33 ,$420.00 ,$273.00 ,$107.33 ,$117.60 ,$212.52 ,$107.33 ,$241.50 ,$107.33 ,$212.48 ,$107.33 ,$203.93 ,$344.40 ,$268.33 ,$107.33 ,$357.00 ,$378.00 ,$107.33 ,$315.00 ,$294.00 ,$310.80 ,$310.80 ,$268.33 ,$357.00 ,$107.33 ,$107.33 ,$294.42 ,$107.33 ,$174.72 , N/A ,$357.00 ,$230.77 ,$117.60 ,$378.00 ,$420.00 ,$107.33 ,$273.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$458.00 ,$297.70 ,$79.75 ,$458.00 ,$297.70 ,$79.75 ,$128.24 ,$231.75 ,$79.75 ,$263.35 ,$79.75 ,$231.70 ,$79.75 ,$151.52 ,$375.56 ,$199.36 ,$79.75 ,$389.30 ,$412.20 ,$79.75 ,$343.50 ,$320.60 ,$338.92 ,$338.92 ,$199.36 ,$389.30 ,$79.75 ,$79.75 ,$321.06 ,$79.75 ,$190.53 , N/A ,$389.30 ,$171.45 ,$128.24 ,$412.20 ,$458.00 ,$79.75 ,$297.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$389.00 ,$252.85 ,$79.75 ,$389.00 ,$252.85 ,$79.75 ,$108.92 ,$196.83 ,$79.75 ,$223.68 ,$79.75 ,$196.80 ,$79.75 ,$151.52 ,$318.98 ,$199.36 ,$79.75 ,$330.65 ,$350.10 ,$79.75 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$199.36 ,$330.65 ,$79.75 ,$79.75 ,$272.69 ,$79.75 ,$161.82 , N/A ,$330.65 ,$171.45 ,$108.92 ,$350.10 ,$389.00 ,$79.75 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,319.00 ",$857.35 ,$363.05 ,"$1,319.00 ",$857.35 ,$363.05 ,$369.32 ,$667.41 ,$363.05 ,$758.43 ,$363.05 ,$667.28 ,$363.05 ,$689.79 ,"$1,081.58 ",$907.62 ,$363.05 ,"$1,121.15 ","$1,187.10 ",$363.05 ,$989.25 ,$923.30 ,$976.06 ,$976.06 ,$907.62 ,"$1,121.15 ",$363.05 ,$363.05 ,$924.62 ,$363.05 ,$548.70 , N/A ,"$1,121.15 ",$780.55 ,$369.32 ,"$1,187.10 ",$475.00 ,$363.05 ,$857.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$479.00 ,$311.35 ,$79.75 ,$479.00 ,$311.35 ,$79.75 ,$134.12 ,$242.37 ,$79.75 ,$275.43 ,$79.75 ,$242.33 ,$79.75 ,$151.52 ,$392.78 ,$199.36 ,$79.75 ,$407.15 ,$431.10 ,$79.75 ,$359.25 ,$335.30 ,$354.46 ,$354.46 ,$199.36 ,$407.15 ,$79.75 ,$79.75 ,$335.78 ,$79.75 ,$199.26 , N/A ,$407.15 ,$171.45 ,$134.12 ,$431.10 ,$475.00 ,$79.75 ,$311.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$487.00 ,$316.55 ,$79.75 ,$487.00 ,$316.55 ,$79.75 ,$136.36 ,$246.42 ,$79.75 ,$280.03 ,$79.75 ,$246.37 ,$79.75 ,$151.52 ,$399.34 ,$199.36 ,$79.75 ,$413.95 ,$438.30 ,$79.75 ,$365.25 ,$340.90 ,$360.38 ,$360.38 ,$199.36 ,$413.95 ,$79.75 ,$79.75 ,$341.39 ,$79.75 ,$202.59 , N/A ,$413.95 ,$171.45 ,$136.36 ,$438.30 ,$475.00 ,$79.75 ,$316.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$562.00 ,$365.30 ,$107.33 ,$562.00 ,$365.30 ,$107.33 ,$157.36 ,$284.37 ,$107.33 ,$323.15 ,$107.33 ,$284.32 ,$107.33 ,$203.93 ,$460.84 ,$268.33 ,$107.33 ,$477.70 ,$505.80 ,$107.33 ,$421.50 ,$393.40 ,$415.88 ,$415.88 ,$268.33 ,$477.70 ,$107.33 ,$107.33 ,$393.96 ,$107.33 ,$233.79 , N/A ,$477.70 ,$230.77 ,$157.36 ,$505.80 ,$475.00 ,$107.33 ,$365.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000267,73565,HC XR KNEE STAND,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,257.00 ",$817.05 ,$351.96 ,"$1,257.00 ",$817.05 ,$363.05 ,$351.96 ,$636.04 ,$363.05 ,$722.78 ,$363.05 ,$635.92 ,$363.05 ,$689.79 ,"$1,030.74 ",$907.62 ,$363.05 ,"$1,068.45 ","$1,131.30 ",$363.05 ,$942.75 ,$879.90 ,$930.18 ,$930.18 ,$907.62 ,"$1,068.45 ",$363.05 ,$363.05 ,$881.16 ,$363.05 ,$522.91 , N/A ,"$1,068.45 ",$780.55 ,$351.96 ,"$1,131.30 ",$475.00 ,$363.05 ,$817.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$420.00 ,$273.00 ,$79.75 ,$420.00 ,$273.00 ,$79.75 ,$117.60 ,$212.52 ,$79.75 ,$241.50 ,$79.75 ,$212.48 ,$79.75 ,$151.52 ,$344.40 ,$199.36 ,$79.75 ,$357.00 ,$378.00 ,$79.75 ,$315.00 ,$294.00 ,$310.80 ,$310.80 ,$199.36 ,$357.00 ,$79.75 ,$79.75 ,$294.42 ,$79.75 ,$174.72 , N/A ,$357.00 ,$171.45 ,$117.60 ,$378.00 ,$420.00 ,$79.75 ,$273.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$458.00 ,$297.70 ,$79.75 ,$458.00 ,$297.70 ,$79.75 ,$128.24 ,$231.75 ,$79.75 ,$263.35 ,$79.75 ,$231.70 ,$79.75 ,$151.52 ,$375.56 ,$199.36 ,$79.75 ,$389.30 ,$412.20 ,$79.75 ,$343.50 ,$320.60 ,$338.92 ,$338.92 ,$199.36 ,$389.30 ,$79.75 ,$79.75 ,$321.06 ,$79.75 ,$190.53 , N/A ,$389.30 ,$171.45 ,$128.24 ,$412.20 ,$458.00 ,$79.75 ,$297.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$420.00 ,$273.00 ,$79.75 ,$420.00 ,$273.00 ,$79.75 ,$117.60 ,$212.52 ,$79.75 ,$241.50 ,$79.75 ,$212.48 ,$79.75 ,$151.52 ,$344.40 ,$199.36 ,$79.75 ,$357.00 ,$378.00 ,$79.75 ,$315.00 ,$294.00 ,$310.80 ,$310.80 ,$199.36 ,$357.00 ,$79.75 ,$79.75 ,$294.42 ,$79.75 ,$174.72 , N/A ,$357.00 ,$171.45 ,$117.60 ,$378.00 ,$420.00 ,$79.75 ,$273.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$487.00 ,$316.55 ,$79.75 ,$487.00 ,$316.55 ,$79.75 ,$136.36 ,$246.42 ,$79.75 ,$280.03 ,$79.75 ,$246.37 ,$79.75 ,$151.52 ,$399.34 ,$199.36 ,$79.75 ,$413.95 ,$438.30 ,$79.75 ,$365.25 ,$340.90 ,$360.38 ,$360.38 ,$199.36 ,$413.95 ,$79.75 ,$79.75 ,$341.39 ,$79.75 ,$202.59 , N/A ,$413.95 ,$171.45 ,$136.36 ,$438.30 ,$475.00 ,$79.75 ,$316.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$389.00 ,$252.85 ,$79.75 ,$389.00 ,$252.85 ,$79.75 ,$108.92 ,$196.83 ,$79.75 ,$223.68 ,$79.75 ,$196.80 ,$79.75 ,$151.52 ,$318.98 ,$199.36 ,$79.75 ,$330.65 ,$350.10 ,$79.75 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$199.36 ,$330.65 ,$79.75 ,$79.75 ,$272.69 ,$79.75 ,$161.82 , N/A ,$330.65 ,$171.45 ,$108.92 ,$350.10 ,$389.00 ,$79.75 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$389.00 ,$252.85 ,$79.75 ,$389.00 ,$252.85 ,$79.75 ,$108.92 ,$196.83 ,$79.75 ,$223.68 ,$79.75 ,$196.80 ,$79.75 ,$151.52 ,$318.98 ,$199.36 ,$79.75 ,$330.65 ,$350.10 ,$79.75 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$199.36 ,$330.65 ,$79.75 ,$79.75 ,$272.69 ,$79.75 ,$161.82 , N/A ,$330.65 ,$171.45 ,$108.92 ,$350.10 ,$389.00 ,$79.75 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$448.00 ,$291.20 ,$79.75 ,$448.00 ,$291.20 ,$79.75 ,$125.44 ,$226.69 ,$79.75 ,$257.60 ,$79.75 ,$226.64 ,$79.75 ,$151.52 ,$367.36 ,$199.36 ,$79.75 ,$380.80 ,$403.20 ,$79.75 ,$336.00 ,$313.60 ,$331.52 ,$331.52 ,$199.36 ,$380.80 ,$79.75 ,$79.75 ,$314.05 ,$79.75 ,$186.37 , N/A ,$380.80 ,$171.45 ,$125.44 ,$403.20 ,$448.00 ,$79.75 ,$291.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$510.00 ,$331.50 ,$107.33 ,$510.00 ,$331.50 ,$107.33 ,$142.80 ,$258.06 ,$107.33 ,$293.25 ,$107.33 ,$258.01 ,$107.33 ,$203.93 ,$418.20 ,$268.33 ,$107.33 ,$433.50 ,$459.00 ,$107.33 ,$382.50 ,$357.00 ,$377.40 ,$377.40 ,$268.33 ,$433.50 ,$107.33 ,$107.33 ,$357.51 ,$107.33 ,$212.16 , N/A ,$433.50 ,$230.77 ,$142.80 ,$459.00 ,$475.00 ,$107.33 ,$331.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$751.00 ,$488.15 ,$107.33 ,$751.00 ,$488.15 ,$107.33 ,$210.28 ,$380.01 ,$107.33 ,$431.83 ,$107.33 ,$379.93 ,$107.33 ,$203.93 ,$615.82 ,$268.33 ,$107.33 ,$638.35 ,$675.90 ,$107.33 ,$563.25 ,$525.70 ,$555.74 ,$555.74 ,$268.33 ,$638.35 ,$107.33 ,$107.33 ,$526.45 ,$107.33 ,$312.42 , N/A ,$638.35 ,$230.77 ,$210.28 ,$675.90 ,$475.00 ,$107.33 ,$488.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$795.00 ,$516.75 ,$176.10 ,$795.00 ,$516.75 ,$176.10 ,$222.60 ,$402.27 ,$176.10 ,$457.13 ,$176.10 ,$402.19 ,$176.10 ,$334.60 ,$651.90 ,$440.26 ,$176.10 ,$675.75 ,$715.50 ,$176.10 ,$596.25 ,$556.50 ,$588.30 ,$588.30 ,$440.26 ,$675.75 ,$176.10 ,$176.10 ,$557.30 ,$176.10 ,$330.72 , N/A ,$675.75 ,$378.62 ,$222.60 ,$715.50 ,$475.00 ,$176.10 ,$516.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$795.00 ,$516.75 ,$176.10 ,$795.00 ,$516.75 ,$176.10 ,$222.60 ,$402.27 ,$176.10 ,$457.13 ,$176.10 ,$402.19 ,$176.10 ,$334.60 ,$651.90 ,$440.26 ,$176.10 ,$675.75 ,$715.50 ,$176.10 ,$596.25 ,$556.50 ,$588.30 ,$588.30 ,$440.26 ,$675.75 ,$176.10 ,$176.10 ,$557.30 ,$176.10 ,$330.72 , N/A ,$675.75 ,$378.62 ,$222.60 ,$715.50 ,$475.00 ,$176.10 ,$516.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$475.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,"$1,228.00 ",$798.20 ,$176.10 ,"$1,228.00 ",$798.20 ,$176.10 ,$343.84 ,$621.37 ,$176.10 ,$706.10 ,$176.10 ,$621.25 ,$176.10 ,$334.60 ,"$1,006.96 ",$440.26 ,$176.10 ,"$1,043.80 ","$1,105.20 ",$176.10 ,$921.00 ,$859.60 ,$908.72 ,$908.72 ,$440.26 ,"$1,043.80 ",$176.10 ,$176.10 ,$860.83 ,$176.10 ,$510.85 , N/A ,"$1,043.80 ",$378.62 ,$343.84 ,"$1,105.20 ",$475.00 ,$176.10 ,$798.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$873.00 ,$567.45 ,$176.10 ,$873.00 ,$567.45 ,$176.10 ,$244.44 ,$441.74 ,$176.10 ,$501.98 ,$176.10 ,$441.65 ,$176.10 ,$334.60 ,$715.86 ,$440.26 ,$176.10 ,$742.05 ,$785.70 ,$176.10 ,$654.75 ,$611.10 ,$646.02 ,$646.02 ,$440.26 ,$742.05 ,$176.10 ,$176.10 ,$611.97 ,$176.10 ,$363.17 , N/A ,$742.05 ,$378.62 ,$244.44 ,$785.70 ,$475.00 ,$176.10 ,$567.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000312,74018,HC SITZ MARKER STUDY,320,1 ,$310.00 ,$201.50 ,$79.75 ,$310.00 ,$201.50 ,$79.75 ,$86.80 ,$156.86 ,$79.75 ,$178.25 ,$79.75 ,$156.83 ,$79.75 ,$151.52 ,$254.20 ,$199.36 ,$79.75 ,$263.50 ,$279.00 ,$79.75 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$199.36 ,$263.50 ,$79.75 ,$79.75 ,$217.31 ,$79.75 ,$128.96 , N/A ,$263.50 ,$171.45 ,$86.80 ,$279.00 ,$310.00 ,$79.75 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000315,74270,HC XRAY COLON BARIUM,320,1 ,"$1,127.00 ",$732.55 ,$176.10 ,"$1,127.00 ",$732.55 ,$176.10 ,$315.56 ,$570.26 ,$176.10 ,$648.03 ,$176.10 ,$570.15 ,$176.10 ,$334.60 ,$924.14 ,$440.26 ,$176.10 ,$957.95 ,"$1,014.30 ",$176.10 ,$845.25 ,$788.90 ,$833.98 ,$833.98 ,$440.26 ,$957.95 ,$176.10 ,$176.10 ,$790.03 ,$176.10 ,$468.83 , N/A ,$957.95 ,$378.62 ,$315.56 ,"$1,014.30 ",$475.00 ,$176.10 ,$732.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,"$1,127.00 ",$732.55 ,$176.10 ,"$1,127.00 ",$732.55 ,$176.10 ,$315.56 ,$570.26 ,$176.10 ,$648.03 ,$176.10 ,$570.15 ,$176.10 ,$334.60 ,$924.14 ,$440.26 ,$176.10 ,$957.95 ,"$1,014.30 ",$176.10 ,$845.25 ,$788.90 ,$833.98 ,$833.98 ,$440.26 ,$957.95 ,$176.10 ,$176.10 ,$790.03 ,$176.10 ,$468.83 , N/A ,$957.95 ,$378.62 ,$315.56 ,"$1,014.30 ",$475.00 ,$176.10 ,$732.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,"$1,127.00 ",$732.55 ,$176.10 ,"$1,127.00 ",$732.55 ,$176.10 ,$315.56 ,$570.26 ,$176.10 ,$648.03 ,$176.10 ,$570.15 ,$176.10 ,$334.60 ,$924.14 ,$440.26 ,$176.10 ,$957.95 ,"$1,014.30 ",$176.10 ,$845.25 ,$788.90 ,$833.98 ,$833.98 ,$440.26 ,$957.95 ,$176.10 ,$176.10 ,$790.03 ,$176.10 ,$468.83 , N/A ,$957.95 ,$378.62 ,$315.56 ,"$1,014.30 ",$475.00 ,$176.10 ,$732.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,410.00 ",$916.50 ,$176.10 ,"$1,410.00 ",$916.50 ,$176.10 ,$394.80 ,$713.46 ,$176.10 ,$810.75 ,$176.10 ,$713.32 ,$176.10 ,$334.60 ,"$1,156.20 ",$440.26 ,$176.10 ,"$1,198.50 ","$1,269.00 ",$176.10 ,"$1,057.50 ",$987.00 ,"$1,043.40 ","$1,043.40 ",$440.26 ,"$1,198.50 ",$176.10 ,$176.10 ,$988.41 ,$176.10 ,$586.56 , N/A ,"$1,198.50 ",$378.62 ,$394.80 ,"$1,269.00 ",$475.00 ,$176.10 ,$916.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$931.00 ,$605.15 ,$260.68 ,$931.00 ,$605.15 , N/A ,$260.68 ,$471.09 , N/A ,$535.33 , N/A ,$470.99 , N/A , N/A ,$763.42 , N/A , N/A ,$791.35 ,$837.90 , N/A ,$698.25 ,$651.70 ,$688.94 ,$688.94 , N/A ,$791.35 , N/A , N/A ,$652.63 , N/A ,$387.30 , N/A ,$791.35 , N/A ,$260.68 ,$837.90 ,$475.00 , N/A ,$605.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,"$1,048.00 ",$681.20 ,$293.44 ,"$1,048.00 ",$681.20 ,$363.05 ,$293.44 ,$530.29 ,$363.05 ,$602.60 ,$363.05 ,$530.18 ,$363.05 ,$689.79 ,$859.36 ,$907.62 ,$363.05 ,$890.80 ,$943.20 ,$363.05 ,$786.00 ,$733.60 ,$775.52 ,$775.52 ,$907.62 ,$890.80 ,$363.05 ,$363.05 ,$734.65 ,$363.05 ,$435.97 , N/A ,$890.80 ,$780.55 ,$293.44 ,$943.20 ,$475.00 ,$363.05 ,$681.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,"$1,556.00 ","$1,011.40 ",$363.05 ,"$1,556.00 ","$1,011.40 ",$363.05 ,$435.68 ,$787.34 ,$363.05 ,$894.70 ,$363.05 ,$787.18 ,$363.05 ,$689.79 ,"$1,275.92 ",$907.62 ,$363.05 ,"$1,322.60 ","$1,400.40 ",$363.05 ,"$1,167.00 ","$1,089.20 ","$1,151.44 ","$1,151.44 ",$907.62 ,"$1,322.60 ",$363.05 ,$363.05 ,"$1,090.76 ",$363.05 ,$647.30 , N/A ,"$1,322.60 ",$780.55 ,$435.68 ,"$1,400.40 ",$475.00 ,$363.05 ,"$1,011.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,"$1,556.00 ","$1,011.40 ",$363.05 ,"$1,556.00 ","$1,011.40 ",$363.05 ,$435.68 ,$787.34 ,$363.05 ,$894.70 ,$363.05 ,$787.18 ,$363.05 ,$689.79 ,"$1,275.92 ",$907.62 ,$363.05 ,"$1,322.60 ","$1,400.40 ",$363.05 ,"$1,167.00 ","$1,089.20 ","$1,151.44 ","$1,151.44 ",$907.62 ,"$1,322.60 ",$363.05 ,$363.05 ,"$1,090.76 ",$363.05 ,$647.30 , N/A ,"$1,322.60 ",$780.55 ,$435.68 ,"$1,400.40 ",$475.00 ,$363.05 ,"$1,011.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,"$1,556.00 ","$1,011.40 ",$226.85 ,"$1,556.00 ","$1,011.40 ",$226.85 ,$435.68 ,$787.34 ,$226.85 ,$894.70 ,$226.85 ,$787.18 ,$226.85 ,$431.02 ,"$1,275.92 ",$567.13 ,$226.85 ,"$1,322.60 ","$1,400.40 ",$226.85 ,"$1,167.00 ","$1,089.20 ","$1,151.44 ","$1,151.44 ",$567.13 ,"$1,322.60 ",$226.85 ,$226.85 ,"$1,090.76 ",$226.85 ,$647.30 , N/A ,"$1,322.60 ",$487.73 ,$435.68 ,"$1,400.40 ",$475.00 ,$226.85 ,"$1,011.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,"$1,072.00 ",$696.80 ,$226.85 ,"$1,072.00 ",$696.80 ,$226.85 ,$300.16 ,$542.43 ,$226.85 ,$616.40 ,$226.85 ,$542.32 ,$226.85 ,$431.02 ,$879.04 ,$567.13 ,$226.85 ,$911.20 ,$964.80 ,$226.85 ,$804.00 ,$750.40 ,$793.28 ,$793.28 ,$567.13 ,$911.20 ,$226.85 ,$226.85 ,$751.47 ,$226.85 ,$445.95 , N/A ,$911.20 ,$487.73 ,$300.16 ,$964.80 ,$475.00 ,$226.85 ,$696.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000356,75625,HC ABDOMINAL AORTAGRAM 75625,320,1 ,"$8,149.00 ","$5,296.85 ",$475.00 ,"$8,149.00 ","$5,296.85 ","$2,822.24 ","$2,281.72 ","$4,123.39 ","$2,822.24 ","$4,685.68 ","$2,822.24 ","$4,122.58 ","$2,822.24 ","$5,362.25 ","$6,682.18 ","$7,055.60 ","$2,822.24 ","$6,926.65 ","$7,334.10 ","$2,822.24 ","$6,111.75 ","$5,704.30 ","$6,030.26 ","$6,030.26 ","$7,055.60 ","$6,926.65 ","$2,822.24 ","$2,822.24 ","$5,712.45 ","$2,822.24 ","$3,389.98 ", N/A ,"$6,926.65 ","$6,067.81 ","$2,281.72 ","$7,334.10 ",$475.00 ,"$2,822.24 ","$5,296.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000372,75710,HC ANGIO EXTREMITY UNI OR,320,1 ,"$9,290.00 ","$6,038.50 ",$475.00 ,"$9,290.00 ","$6,038.50 ","$2,822.24 ","$2,601.20 ","$4,700.74 ","$2,822.24 ","$5,341.75 ","$2,822.24 ","$4,699.81 ","$2,822.24 ","$5,362.25 ","$7,617.80 ","$7,055.60 ","$2,822.24 ","$7,896.50 ","$8,361.00 ","$2,822.24 ","$6,967.50 ","$6,503.00 ","$6,874.60 ","$6,874.60 ","$7,055.60 ","$7,896.50 ","$2,822.24 ","$2,822.24 ","$6,512.29 ","$2,822.24 ","$3,864.64 ", N/A ,"$7,896.50 ","$6,067.81 ","$2,601.20 ","$8,361.00 ",$475.00 ,"$2,822.24 ","$6,038.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$655.00 ,$425.75 ,$183.40 ,$655.00 ,$425.75 ,$226.85 ,$183.40 ,$331.43 ,$226.85 ,$376.63 ,$226.85 ,$331.36 ,$226.85 ,$431.02 ,$537.10 ,$567.13 ,$226.85 ,$556.75 ,$589.50 ,$226.85 ,$491.25 ,$458.50 ,$484.70 ,$484.70 ,$567.13 ,$556.75 ,$226.85 ,$226.85 ,$459.16 ,$226.85 ,$272.48 , N/A ,$556.75 ,$487.73 ,$183.40 ,$589.50 ,$475.00 ,$226.85 ,$425.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$537.00 ,$349.05 ,$150.36 ,"$1,190.92 ",$349.05 ,$476.37 ,$150.36 ,$271.72 ,$476.37 ,$308.78 ,$476.37 ,$271.67 ,$476.37 ,$537.00 ,$440.34 ,"$1,190.92 ",$476.37 ,$456.45 ,$483.30 ,$476.37 ,$402.75 ,$375.90 ,$397.38 ,$397.38 ,$537.00 ,$456.45 ,$476.37 ,$476.37 ,$376.44 ,$476.37 ,$223.39 , N/A ,$456.45 ,"$1,024.19 ",$150.36 ,$483.30 ,$475.00 ,$476.37 ,$349.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$694.00 ,$451.10 ,$194.32 ,$694.00 ,$451.10 , N/A ,$194.32 ,$351.16 , N/A ,$399.05 , N/A ,$351.09 , N/A , N/A ,$569.08 , N/A , N/A ,$589.90 ,$624.60 , N/A ,$520.50 ,$485.80 ,$513.56 ,$513.56 , N/A ,$589.90 , N/A , N/A ,$486.49 , N/A ,$288.70 , N/A ,$589.90 , N/A ,$194.32 ,$624.60 ,$475.00 , N/A ,$451.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$177.00 ,$115.05 ,$49.56 ,$177.00 ,$115.05 , N/A ,$49.56 ,$89.56 , N/A ,$101.78 , N/A ,$89.54 , N/A , N/A ,$145.14 , N/A , N/A ,$150.45 ,$159.30 , N/A ,$132.75 ,$123.90 ,$130.98 ,$130.98 , N/A ,$150.45 , N/A , N/A ,$124.08 , N/A ,$73.63 , N/A ,$150.45 , N/A ,$49.56 ,$159.30 ,$177.00 , N/A ,$115.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$905.00 ,$588.25 ,$253.40 ,$905.00 ,$588.25 , N/A ,$253.40 ,$457.93 , N/A ,$520.38 , N/A ,$457.84 , N/A , N/A ,$742.10 , N/A , N/A ,$769.25 ,$814.50 , N/A ,$678.75 ,$633.50 ,$669.70 ,$669.70 , N/A ,$769.25 , N/A , N/A ,$634.41 , N/A ,$376.48 , N/A ,$769.25 , N/A ,$253.40 ,$814.50 ,$475.00 , N/A ,$588.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$882.00 ,$573.30 ,$246.96 ,"$1,533.75 ",$573.30 ,$613.50 ,$246.96 ,$446.29 ,$613.50 ,$507.15 ,$613.50 ,$446.20 ,$613.50 ,$882.00 ,$723.24 ,"$1,533.75 ",$613.50 ,$749.70 ,$793.80 ,$613.50 ,$661.50 ,$617.40 ,$652.68 ,$652.68 ,$882.00 ,$749.70 ,$613.50 ,$613.50 ,$618.28 ,$613.50 ,$366.91 , N/A ,$749.70 ,"$1,319.02 ",$246.96 ,$793.80 ,$475.00 ,$613.50 ,$573.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$537.00 ,$349.05 ,$107.33 ,$537.00 ,$349.05 ,$107.33 ,$150.36 ,$271.72 ,$107.33 ,$308.78 ,$107.33 ,$271.67 ,$107.33 ,$203.93 ,$440.34 ,$268.33 ,$107.33 ,$456.45 ,$483.30 ,$107.33 ,$402.75 ,$375.90 ,$397.38 ,$397.38 ,$268.33 ,$456.45 ,$107.33 ,$107.33 ,$376.44 ,$107.33 ,$223.39 , N/A ,$456.45 ,$230.77 ,$150.36 ,$483.30 ,$475.00 ,$107.33 ,$349.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000493,77074,HC BONE SURVEY LIMITED,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000496,77080,HC BONE DENSITY DXA,320,1 ,$649.00 ,$421.85 ,$107.33 ,$649.00 ,$421.85 ,$107.33 ,$181.72 ,$328.39 ,$107.33 ,$373.18 ,$107.33 ,$328.33 ,$107.33 ,$203.93 ,$532.18 ,$268.33 ,$107.33 ,$551.65 ,$584.10 ,$107.33 ,$486.75 ,$454.30 ,$480.26 ,$480.26 ,$268.33 ,$551.65 ,$107.33 ,$107.33 ,$454.95 ,$107.33 ,$269.98 , N/A ,$551.65 ,$230.77 ,$181.72 ,$584.10 ,$475.00 ,$107.33 ,$421.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$708.00 ,$460.20 ,$79.75 ,$708.00 ,$460.20 ,$79.75 ,$198.24 ,$358.25 ,$79.75 ,$407.10 ,$79.75 ,$358.18 ,$79.75 ,$151.52 ,$580.56 ,$199.36 ,$79.75 ,$601.80 ,$637.20 ,$79.75 ,$531.00 ,$495.60 ,$523.92 ,$523.92 ,$199.36 ,$601.80 ,$79.75 ,$79.75 ,$496.31 ,$79.75 ,$294.53 , N/A ,$601.80 ,$171.45 ,$198.24 ,$637.20 ,$475.00 ,$79.75 ,$460.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$655.00 ,$425.75 ,$183.40 ,$655.00 ,$425.75 ,$226.85 ,$183.40 ,$331.43 ,$226.85 ,$376.63 ,$226.85 ,$331.36 ,$226.85 ,$431.02 ,$537.10 ,$567.13 ,$226.85 ,$556.75 ,$589.50 ,$226.85 ,$491.25 ,$458.50 ,$484.70 ,$484.70 ,$567.13 ,$556.75 ,$226.85 ,$226.85 ,$459.16 ,$226.85 ,$272.48 , N/A ,$556.75 ,$487.73 ,$183.40 ,$589.50 ,$475.00 ,$226.85 ,$425.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000509,77072,HC BONE AGE STUDIES,320,1 ,$381.00 ,$247.65 ,$106.68 ,$381.00 ,$247.65 ,$107.33 ,$106.68 ,$192.79 ,$107.33 ,$219.08 ,$107.33 ,$192.75 ,$107.33 ,$203.93 ,$312.42 ,$268.33 ,$107.33 ,$323.85 ,$342.90 ,$107.33 ,$285.75 ,$266.70 ,$281.94 ,$281.94 ,$268.33 ,$323.85 ,$107.33 ,$107.33 ,$267.08 ,$107.33 ,$158.50 , N/A ,$323.85 ,$230.77 ,$106.68 ,$342.90 ,$381.00 ,$107.33 ,$247.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000543,72074,HC XR T-SPINE 4 + VIEWS,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000551,77077,HC XR JOINT SRVY SINGLE 2 JOINTS,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000552,70100,HC XR MANDIBLE <3V,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000568,70190,HC XR EYE SOCKETS,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$652.00 ,$423.80 ,$107.33 ,$652.00 ,$423.80 ,$107.33 ,$182.56 ,$329.91 ,$107.33 ,$374.90 ,$107.33 ,$329.85 ,$107.33 ,$203.93 ,$534.64 ,$268.33 ,$107.33 ,$554.20 ,$586.80 ,$107.33 ,$489.00 ,$456.40 ,$482.48 ,$482.48 ,$268.33 ,$554.20 ,$107.33 ,$107.33 ,$457.05 ,$107.33 ,$271.23 , N/A ,$554.20 ,$230.77 ,$182.56 ,$586.80 ,$475.00 ,$107.33 ,$423.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$458.00 ,$297.70 ,$79.75 ,$458.00 ,$297.70 ,$79.75 ,$128.24 ,$231.75 ,$79.75 ,$263.35 ,$79.75 ,$231.70 ,$79.75 ,$151.52 ,$375.56 ,$199.36 ,$79.75 ,$389.30 ,$412.20 ,$79.75 ,$343.50 ,$320.60 ,$338.92 ,$338.92 ,$199.36 ,$389.30 ,$79.75 ,$79.75 ,$321.06 ,$79.75 ,$190.53 , N/A ,$389.30 ,$171.45 ,$128.24 ,$412.20 ,$458.00 ,$79.75 ,$297.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$652.00 ,$423.80 ,$107.33 ,$652.00 ,$423.80 ,$107.33 ,$182.56 ,$329.91 ,$107.33 ,$374.90 ,$107.33 ,$329.85 ,$107.33 ,$203.93 ,$534.64 ,$268.33 ,$107.33 ,$554.20 ,$586.80 ,$107.33 ,$489.00 ,$456.40 ,$482.48 ,$482.48 ,$268.33 ,$554.20 ,$107.33 ,$107.33 ,$457.05 ,$107.33 ,$271.23 , N/A ,$554.20 ,$230.77 ,$182.56 ,$586.80 ,$475.00 ,$107.33 ,$423.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$236.00 ,$153.40 ,$66.08 ,$268.33 ,$153.40 ,$107.33 ,$66.08 ,$119.42 ,$107.33 ,$135.70 ,$107.33 ,$119.39 ,$107.33 ,$203.93 ,$193.52 ,$268.33 ,$107.33 ,$200.60 ,$212.40 ,$107.33 ,$177.00 ,$165.20 ,$174.64 ,$174.64 ,$236.00 ,$200.60 ,$107.33 ,$107.33 ,$165.44 ,$107.33 ,$98.18 , N/A ,$200.60 ,$230.77 ,$66.08 ,$212.40 ,$236.00 ,$107.33 ,$153.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$427.00 ,$277.55 ,$79.75 ,$427.00 ,$277.55 ,$79.75 ,$119.56 ,$216.06 ,$79.75 ,$245.53 ,$79.75 ,$216.02 ,$79.75 ,$151.52 ,$350.14 ,$199.36 ,$79.75 ,$362.95 ,$384.30 ,$79.75 ,$320.25 ,$298.90 ,$315.98 ,$315.98 ,$199.36 ,$362.95 ,$79.75 ,$79.75 ,$299.33 ,$79.75 ,$177.63 , N/A ,$362.95 ,$171.45 ,$119.56 ,$384.30 ,$427.00 ,$79.75 ,$277.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000583,72200,HC XR SACROILIC JOINT <3VIEWS,320,1 ,$389.00 ,$252.85 ,$107.33 ,$389.00 ,$252.85 ,$107.33 ,$108.92 ,$196.83 ,$107.33 ,$223.68 ,$107.33 ,$196.80 ,$107.33 ,$203.93 ,$318.98 ,$268.33 ,$107.33 ,$330.65 ,$350.10 ,$107.33 ,$291.75 ,$272.30 ,$287.86 ,$287.86 ,$268.33 ,$330.65 ,$107.33 ,$107.33 ,$272.69 ,$107.33 ,$161.82 , N/A ,$330.65 ,$230.77 ,$108.92 ,$350.10 ,$389.00 ,$107.33 ,$252.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,"$1,210.00 ",$786.50 ,$338.80 ,"$1,210.00 ",$786.50 , N/A ,$338.80 ,$612.26 , N/A ,$695.75 , N/A ,$612.14 , N/A , N/A ,$992.20 , N/A , N/A ,"$1,028.50 ","$1,089.00 ", N/A ,$907.50 ,$847.00 ,$895.40 ,$895.40 , N/A ,"$1,028.50 ", N/A , N/A ,$848.21 , N/A ,$503.36 , N/A ,"$1,028.50 ", N/A ,$338.80 ,"$1,089.00 ",$475.00 , N/A ,$786.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$208.00 ,$135.20 ,$58.24 ,$208.00 ,$135.20 ,$61.12 ,$58.24 ,$105.25 ,$61.12 ,$119.60 ,$61.12 ,$105.23 ,$61.12 ,$116.14 ,$170.56 ,$152.81 ,$61.12 ,$176.80 ,$187.20 ,$61.12 ,$156.00 ,$145.60 ,$153.92 ,$153.92 ,$152.81 ,$176.80 ,$61.12 ,$61.12 ,$145.81 ,$61.12 ,$86.53 , N/A ,$176.80 ,$131.42 ,$58.24 ,$187.20 ,$208.00 ,$61.12 ,$135.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$623.00 ,$404.95 ,$174.44 ,$785.87 ,$404.95 ,$314.35 ,$174.44 ,$315.24 ,$314.35 ,$358.23 ,$314.35 ,$315.18 ,$314.35 ,$597.26 ,$510.86 ,$785.87 ,$314.35 ,$529.55 ,$560.70 ,$314.35 ,$467.25 ,$436.10 ,$461.02 ,$461.02 ,$623.00 ,$529.55 ,$314.35 ,$314.35 ,$436.72 ,$314.35 ,$259.17 , N/A ,$529.55 ,$675.85 ,$174.44 ,$560.70 ,$623.00 ,$314.35 ,$404.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$208.00 ,$135.20 ,$58.24 ,$208.00 ,$135.20 ,$61.12 ,$58.24 ,$105.25 ,$61.12 ,$119.60 ,$61.12 ,$105.23 ,$61.12 ,$116.14 ,$170.56 ,$152.81 ,$61.12 ,$176.80 ,$187.20 ,$61.12 ,$156.00 ,$145.60 ,$153.92 ,$153.92 ,$152.81 ,$176.80 ,$61.12 ,$61.12 ,$145.81 ,$61.12 ,$86.53 , N/A ,$176.80 ,$131.42 ,$58.24 ,$187.20 ,$208.00 ,$61.12 ,$135.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,647.00 ","$1,070.55 ",$371.64 ,"$1,647.00 ","$1,070.55 ",$371.64 ,$461.16 ,$833.38 ,$371.64 ,$947.03 ,$371.64 ,$833.22 ,$371.64 ,$706.11 ,"$1,350.54 ",$929.10 ,$371.64 ,"$1,399.95 ","$1,482.30 ",$371.64 ,"$1,235.25 ","$1,152.90 ","$1,218.78 ","$1,218.78 ",$929.10 ,"$1,399.95 ",$371.64 ,$371.64 ,"$1,154.55 ",$371.64 ,$685.15 , N/A ,"$1,399.95 ",$799.02 ,$461.16 ,"$1,482.30 ","$1,115.00 ",$371.64 ,"$1,070.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000006,78013,HC NM THYROID SCAN,340,1 ,"$1,061.00 ",$689.65 ,$297.08 ,"$1,061.00 ",$689.65 ,$371.64 ,$297.08 ,$536.87 ,$371.64 ,$610.08 ,$371.64 ,$536.76 ,$371.64 ,$706.11 ,$870.02 ,$929.10 ,$371.64 ,$901.85 ,$954.90 ,$371.64 ,$795.75 ,$742.70 ,$785.14 ,$785.14 ,$929.10 ,$901.85 ,$371.64 ,$371.64 ,$743.76 ,$371.64 ,$441.38 , N/A ,$901.85 ,$799.02 ,$297.08 ,$954.90 ,"$1,061.00 ",$371.64 ,$689.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,647.00 ","$1,070.55 ",$371.64 ,"$1,647.00 ","$1,070.55 ",$371.64 ,$461.16 ,$833.38 ,$371.64 ,$947.03 ,$371.64 ,$833.22 ,$371.64 ,$706.11 ,"$1,350.54 ",$929.10 ,$371.64 ,"$1,399.95 ","$1,482.30 ",$371.64 ,"$1,235.25 ","$1,152.90 ","$1,218.78 ","$1,218.78 ",$929.10 ,"$1,399.95 ",$371.64 ,$371.64 ,"$1,154.55 ",$371.64 ,$685.15 , N/A ,"$1,399.95 ",$799.02 ,$461.16 ,"$1,482.30 ","$1,115.00 ",$371.64 ,"$1,070.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$3,220.00 ","$2,093.00 ",$482.45 ,"$3,220.00 ","$2,093.00 ",$482.45 ,$901.60 ,"$1,629.32 ",$482.45 ,"$1,851.50 ",$482.45 ,"$1,629.00 ",$482.45 ,$916.65 ,"$2,640.40 ","$1,206.12 ",$482.45 ,"$2,737.00 ","$2,898.00 ",$482.45 ,"$2,415.00 ","$2,254.00 ","$2,382.80 ","$2,382.80 ","$1,206.12 ","$2,737.00 ",$482.45 ,$482.45 ,"$2,257.22 ",$482.45 ,"$1,339.52 ", N/A ,"$2,737.00 ","$1,037.26 ",$901.60 ,"$2,898.00 ","$1,115.00 ",$482.45 ,"$2,093.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$2,222.00 ","$1,444.30 ",$371.64 ,"$2,222.00 ","$1,444.30 ",$371.64 ,$622.16 ,"$1,124.33 ",$371.64 ,"$1,277.65 ",$371.64 ,"$1,124.11 ",$371.64 ,$706.11 ,"$1,822.04 ",$929.10 ,$371.64 ,"$1,888.70 ","$1,999.80 ",$371.64 ,"$1,666.50 ","$1,555.40 ","$1,644.28 ","$1,644.28 ",$929.10 ,"$1,888.70 ",$371.64 ,$371.64 ,"$1,557.62 ",$371.64 ,$924.35 , N/A ,"$1,888.70 ",$799.02 ,$622.16 ,"$1,999.80 ","$1,115.00 ",$371.64 ,"$1,444.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,222.00 ","$1,444.30 ",$371.64 ,"$2,222.00 ","$1,444.30 ",$371.64 ,$622.16 ,"$1,124.33 ",$371.64 ,"$1,277.65 ",$371.64 ,"$1,124.11 ",$371.64 ,$706.11 ,"$1,822.04 ",$929.10 ,$371.64 ,"$1,888.70 ","$1,999.80 ",$371.64 ,"$1,666.50 ","$1,555.40 ","$1,644.28 ","$1,644.28 ",$929.10 ,"$1,888.70 ",$371.64 ,$371.64 ,"$1,557.62 ",$371.64 ,$924.35 , N/A ,"$1,888.70 ",$799.02 ,$622.16 ,"$1,999.80 ","$1,115.00 ",$371.64 ,"$1,444.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,815.00 ","$1,179.75 ",$371.64 ,"$1,815.00 ","$1,179.75 ",$371.64 ,$508.20 ,$918.39 ,$371.64 ,"$1,043.63 ",$371.64 ,$918.21 ,$371.64 ,$706.11 ,"$1,488.30 ",$929.10 ,$371.64 ,"$1,542.75 ","$1,633.50 ",$371.64 ,"$1,361.25 ","$1,270.50 ","$1,343.10 ","$1,343.10 ",$929.10 ,"$1,542.75 ",$371.64 ,$371.64 ,"$1,272.32 ",$371.64 ,$755.04 , N/A ,"$1,542.75 ",$799.02 ,$508.20 ,"$1,633.50 ","$1,115.00 ",$371.64 ,"$1,179.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,815.00 ","$1,179.75 ",$371.64 ,"$1,815.00 ","$1,179.75 ",$371.64 ,$508.20 ,$918.39 ,$371.64 ,"$1,043.63 ",$371.64 ,$918.21 ,$371.64 ,$706.11 ,"$1,488.30 ",$929.10 ,$371.64 ,"$1,542.75 ","$1,633.50 ",$371.64 ,"$1,361.25 ","$1,270.50 ","$1,343.10 ","$1,343.10 ",$929.10 ,"$1,542.75 ",$371.64 ,$371.64 ,"$1,272.32 ",$371.64 ,$755.04 , N/A ,"$1,542.75 ",$799.02 ,$508.20 ,"$1,633.50 ","$1,115.00 ",$371.64 ,"$1,179.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,815.00 ","$1,179.75 ",$371.64 ,"$1,815.00 ","$1,179.75 ",$371.64 ,$508.20 ,$918.39 ,$371.64 ,"$1,043.63 ",$371.64 ,$918.21 ,$371.64 ,$706.11 ,"$1,488.30 ",$929.10 ,$371.64 ,"$1,542.75 ","$1,633.50 ",$371.64 ,"$1,361.25 ","$1,270.50 ","$1,343.10 ","$1,343.10 ",$929.10 ,"$1,542.75 ",$371.64 ,$371.64 ,"$1,272.32 ",$371.64 ,$755.04 , N/A ,"$1,542.75 ",$799.02 ,$508.20 ,"$1,633.50 ","$1,115.00 ",$371.64 ,"$1,179.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,849.00 ","$1,201.85 ",$371.64 ,"$1,849.00 ","$1,201.85 ",$371.64 ,$517.72 ,$935.59 ,$371.64 ,"$1,063.18 ",$371.64 ,$935.41 ,$371.64 ,$706.11 ,"$1,516.18 ",$929.10 ,$371.64 ,"$1,571.65 ","$1,664.10 ",$371.64 ,"$1,386.75 ","$1,294.30 ","$1,368.26 ","$1,368.26 ",$929.10 ,"$1,571.65 ",$371.64 ,$371.64 ,"$1,296.15 ",$371.64 ,$769.18 , N/A ,"$1,571.65 ",$799.02 ,$517.72 ,"$1,664.10 ","$1,115.00 ",$371.64 ,"$1,201.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000030,78305,HC BONE SCAN MULTIPLE,340,1 ,"$1,849.00 ","$1,201.85 ",$371.64 ,"$1,849.00 ","$1,201.85 ",$371.64 ,$517.72 ,$935.59 ,$371.64 ,"$1,063.18 ",$371.64 ,$935.41 ,$371.64 ,$706.11 ,"$1,516.18 ",$929.10 ,$371.64 ,"$1,571.65 ","$1,664.10 ",$371.64 ,"$1,386.75 ","$1,294.30 ","$1,368.26 ","$1,368.26 ",$929.10 ,"$1,571.65 ",$371.64 ,$371.64 ,"$1,296.15 ",$371.64 ,$769.18 , N/A ,"$1,571.65 ",$799.02 ,$517.72 ,"$1,664.10 ","$1,115.00 ",$371.64 ,"$1,201.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$1,849.00 ","$1,201.85 ",$371.64 ,"$1,849.00 ","$1,201.85 ",$371.64 ,$517.72 ,$935.59 ,$371.64 ,"$1,063.18 ",$371.64 ,$935.41 ,$371.64 ,$706.11 ,"$1,516.18 ",$929.10 ,$371.64 ,"$1,571.65 ","$1,664.10 ",$371.64 ,"$1,386.75 ","$1,294.30 ","$1,368.26 ","$1,368.26 ",$929.10 ,"$1,571.65 ",$371.64 ,$371.64 ,"$1,296.15 ",$371.64 ,$769.18 , N/A ,"$1,571.65 ",$799.02 ,$517.72 ,"$1,664.10 ","$1,115.00 ",$371.64 ,"$1,201.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000032,78315,HC BONE SCAN FLOW WHOLE BODY STATICS,340,1 ,"$1,849.00 ","$1,201.85 ",$371.64 ,"$1,849.00 ","$1,201.85 ",$371.64 ,$517.72 ,$935.59 ,$371.64 ,"$1,063.18 ",$371.64 ,$935.41 ,$371.64 ,$706.11 ,"$1,516.18 ",$929.10 ,$371.64 ,"$1,571.65 ","$1,664.10 ",$371.64 ,"$1,386.75 ","$1,294.30 ","$1,368.26 ","$1,368.26 ",$929.10 ,"$1,571.65 ",$371.64 ,$371.64 ,"$1,296.15 ",$371.64 ,$769.18 , N/A ,"$1,571.65 ",$799.02 ,$517.72 ,"$1,664.10 ","$1,115.00 ",$371.64 ,"$1,201.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$2,730.00 ","$1,774.50 ",$764.40 ,"$3,220.84 ","$1,774.50 ","$1,288.34 ",$764.40 ,"$1,381.38 ","$1,288.34 ","$1,569.75 ","$1,288.34 ","$1,381.11 ","$1,288.34 ","$2,447.84 ","$2,238.60 ","$3,220.84 ","$1,288.34 ","$2,320.50 ","$2,457.00 ","$1,288.34 ","$2,047.50 ","$1,911.00 ","$2,020.20 ","$2,020.20 ","$2,730.00 ","$2,320.50 ","$1,288.34 ","$1,288.34 ","$1,913.73 ","$1,288.34 ","$1,135.68 ", N/A ,"$2,320.50 ","$2,769.92 ",$764.40 ,"$2,457.00 ","$1,115.00 ","$1,288.34 ","$1,774.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$5,458.00 ","$3,547.70 ","$1,115.00 ","$5,458.00 ","$3,547.70 ","$1,288.34 ","$1,528.24 ","$2,761.75 ","$1,288.34 ","$3,138.35 ","$1,288.34 ","$2,761.20 ","$1,288.34 ","$2,447.84 ","$4,475.56 ","$3,220.84 ","$1,288.34 ","$4,639.30 ","$4,912.20 ","$1,288.34 ","$4,093.50 ","$3,820.60 ","$4,038.92 ","$4,038.92 ","$3,220.84 ","$4,639.30 ","$1,288.34 ","$1,288.34 ","$3,826.06 ","$1,288.34 ","$2,270.53 ", N/A ,"$4,639.30 ","$2,769.92 ","$1,528.24 ","$4,912.20 ","$1,115.00 ","$1,288.34 ","$3,547.70 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,135.00 ","$1,387.75 ",$371.64 ,"$2,135.00 ","$1,387.75 ",$371.64 ,$597.80 ,"$1,080.31 ",$371.64 ,"$1,227.63 ",$371.64 ,"$1,080.10 ",$371.64 ,$706.11 ,"$1,750.70 ",$929.10 ,$371.64 ,"$1,814.75 ","$1,921.50 ",$371.64 ,"$1,601.25 ","$1,494.50 ","$1,579.90 ","$1,579.90 ",$929.10 ,"$1,814.75 ",$371.64 ,$371.64 ,"$1,496.64 ",$371.64 ,$888.16 , N/A ,"$1,814.75 ",$799.02 ,$597.80 ,"$1,921.50 ","$1,115.00 ",$371.64 ,"$1,387.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000047,78580,HC LUNG PERFUS,340,1 ,"$1,441.00 ",$936.65 ,$371.64 ,"$1,441.00 ",$936.65 ,$371.64 ,$403.48 ,$729.15 ,$371.64 ,$828.58 ,$371.64 ,$729.00 ,$371.64 ,$706.11 ,"$1,181.62 ",$929.10 ,$371.64 ,"$1,224.85 ","$1,296.90 ",$371.64 ,"$1,080.75 ","$1,008.70 ","$1,066.34 ","$1,066.34 ",$929.10 ,"$1,224.85 ",$371.64 ,$371.64 ,"$1,010.14 ",$371.64 ,$599.46 , N/A ,"$1,224.85 ",$799.02 ,$403.48 ,"$1,296.90 ","$1,115.00 ",$371.64 ,$936.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$2,261.00 ","$1,469.65 ",$482.45 ,"$2,261.00 ","$1,469.65 ",$482.45 ,$633.08 ,"$1,144.07 ",$482.45 ,"$1,300.08 ",$482.45 ,"$1,143.84 ",$482.45 ,$916.65 ,"$1,854.02 ","$1,206.12 ",$482.45 ,"$1,921.85 ","$2,034.90 ",$482.45 ,"$1,695.75 ","$1,582.70 ","$1,673.14 ","$1,673.14 ","$1,206.12 ","$1,921.85 ",$482.45 ,$482.45 ,"$1,584.96 ",$482.45 ,$940.58 , N/A ,"$1,921.85 ","$1,037.26 ",$633.08 ,"$2,034.90 ","$1,115.00 ",$482.45 ,"$1,469.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000052,78579,HC LUNG SCAN-VENTILATION,340,1 ,"$1,074.00 ",$698.10 ,$300.72 ,"$1,074.00 ",$698.10 ,$371.64 ,$300.72 ,$543.44 ,$371.64 ,$617.55 ,$371.64 ,$543.34 ,$371.64 ,$706.11 ,$880.68 ,$929.10 ,$371.64 ,$912.90 ,$966.60 ,$371.64 ,$805.50 ,$751.80 ,$794.76 ,$794.76 ,$929.10 ,$912.90 ,$371.64 ,$371.64 ,$752.87 ,$371.64 ,$446.78 , N/A ,$912.90 ,$799.02 ,$300.72 ,$966.60 ,"$1,074.00 ",$371.64 ,$698.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$2,269.00 ","$1,474.85 ",$482.45 ,"$2,269.00 ","$1,474.85 ",$482.45 ,$635.32 ,"$1,148.11 ",$482.45 ,"$1,304.68 ",$482.45 ,"$1,147.89 ",$482.45 ,$916.65 ,"$1,860.58 ","$1,206.12 ",$482.45 ,"$1,928.65 ","$2,042.10 ",$482.45 ,"$1,701.75 ","$1,588.30 ","$1,679.06 ","$1,679.06 ","$1,206.12 ","$1,928.65 ",$482.45 ,$482.45 ,"$1,590.57 ",$482.45 ,$943.90 , N/A ,"$1,928.65 ","$1,037.26 ",$635.32 ,"$2,042.10 ","$1,115.00 ",$482.45 ,"$1,474.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$2,269.00 ","$1,474.85 ",$482.45 ,"$2,269.00 ","$1,474.85 ",$482.45 ,$635.32 ,"$1,148.11 ",$482.45 ,"$1,304.68 ",$482.45 ,"$1,147.89 ",$482.45 ,$916.65 ,"$1,860.58 ","$1,206.12 ",$482.45 ,"$1,928.65 ","$2,042.10 ",$482.45 ,"$1,701.75 ","$1,588.30 ","$1,679.06 ","$1,679.06 ","$1,206.12 ","$1,928.65 ",$482.45 ,$482.45 ,"$1,590.57 ",$482.45 ,$943.90 , N/A ,"$1,928.65 ","$1,037.26 ",$635.32 ,"$2,042.10 ","$1,115.00 ",$482.45 ,"$1,474.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$2,269.00 ","$1,474.85 ",$482.45 ,"$2,269.00 ","$1,474.85 ",$482.45 ,$635.32 ,"$1,148.11 ",$482.45 ,"$1,304.68 ",$482.45 ,"$1,147.89 ",$482.45 ,$916.65 ,"$1,860.58 ","$1,206.12 ",$482.45 ,"$1,928.65 ","$2,042.10 ",$482.45 ,"$1,701.75 ","$1,588.30 ","$1,679.06 ","$1,679.06 ","$1,206.12 ","$1,928.65 ",$482.45 ,$482.45 ,"$1,590.57 ",$482.45 ,$943.90 , N/A ,"$1,928.65 ","$1,037.26 ",$635.32 ,"$2,042.10 ","$1,115.00 ",$482.45 ,"$1,474.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$3,719.00 ","$2,417.35 ","$1,041.32 ","$3,719.00 ","$2,417.35 ","$1,288.34 ","$1,041.32 ","$1,881.81 ","$1,288.34 ","$2,138.43 ","$1,288.34 ","$1,881.44 ","$1,288.34 ","$2,447.84 ","$3,049.58 ","$3,220.84 ","$1,288.34 ","$3,161.15 ","$3,347.10 ","$1,288.34 ","$2,789.25 ","$2,603.30 ","$2,752.06 ","$2,752.06 ","$3,220.84 ","$3,161.15 ","$1,288.34 ","$1,288.34 ","$2,607.02 ","$1,288.34 ","$1,547.10 ", N/A ,"$3,161.15 ","$2,769.92 ","$1,041.32 ","$3,347.10 ","$1,115.00 ","$1,288.34 ","$2,417.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,222.00 ","$1,444.30 ",$482.45 ,"$2,222.00 ","$1,444.30 ",$482.45 ,$622.16 ,"$1,124.33 ",$482.45 ,"$1,277.65 ",$482.45 ,"$1,124.11 ",$482.45 ,$916.65 ,"$1,822.04 ","$1,206.12 ",$482.45 ,"$1,888.70 ","$1,999.80 ",$482.45 ,"$1,666.50 ","$1,555.40 ","$1,644.28 ","$1,644.28 ","$1,206.12 ","$1,888.70 ",$482.45 ,$482.45 ,"$1,557.62 ",$482.45 ,$924.35 , N/A ,"$1,888.70 ","$1,037.26 ",$622.16 ,"$1,999.80 ","$1,115.00 ",$482.45 ,"$1,444.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$1,074.00 ",$698.10 ,$300.72 ,"$1,074.00 ",$698.10 ,$371.64 ,$300.72 ,$543.44 ,$371.64 ,$617.55 ,$371.64 ,$543.34 ,$371.64 ,$706.11 ,$880.68 ,$929.10 ,$371.64 ,$912.90 ,$966.60 ,$371.64 ,$805.50 ,$751.80 ,$794.76 ,$794.76 ,$929.10 ,$912.90 ,$371.64 ,$371.64 ,$752.87 ,$371.64 ,$446.78 , N/A ,$912.90 ,$799.02 ,$300.72 ,$966.60 ,"$1,074.00 ",$371.64 ,$698.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$287.00 ,$186.55 ,$80.36 ,$287.00 ,$186.55 , N/A ,$80.36 ,$145.22 , N/A ,$165.03 , N/A ,$145.19 , N/A , N/A ,$235.34 , N/A , N/A ,$243.95 ,$258.30 , N/A ,$215.25 ,$200.90 ,$212.38 ,$212.38 , N/A ,$243.95 , N/A , N/A ,$201.19 , N/A ,$119.39 , N/A ,$243.95 , N/A ,$80.36 ,$258.30 ,$287.00 , N/A ,$186.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$173.00 ,$112.45 ,$26.83 ,$173.00 ,$112.45 , N/A ,$48.44 ,$87.54 , N/A ,$99.48 , N/A ,$87.52 , N/A , N/A ,$141.86 , N/A , N/A ,$147.05 ,$155.70 , N/A ,$129.75 ,$121.10 ,$128.02 ,$128.02 , N/A ,$147.05 , N/A , N/A ,$121.27 , N/A ,$71.97 , N/A ,$147.05 , N/A ,$48.44 ,$155.70 ,$26.83 , N/A ,$112.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$125.00 ,$81.25 ,$35.00 ,$125.00 ,$81.25 , N/A ,$35.00 ,$63.25 , N/A ,$71.88 , N/A ,$63.24 , N/A , N/A ,$102.50 , N/A , N/A ,$106.25 ,$112.50 , N/A ,$93.75 ,$87.50 ,$92.50 ,$92.50 , N/A ,$106.25 , N/A , N/A ,$87.63 , N/A ,$52.00 , N/A ,$106.25 , N/A ,$35.00 ,$112.50 ,$125.00 , N/A ,$81.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$93.00 ,$60.45 ,$26.04 ,$93.00 ,$60.45 , N/A ,$26.04 ,$47.06 , N/A ,$53.48 , N/A ,$47.05 , N/A , N/A ,$76.26 , N/A , N/A ,$79.05 ,$83.70 , N/A ,$69.75 ,$65.10 ,$68.82 ,$68.82 , N/A ,$79.05 , N/A , N/A ,$65.19 , N/A ,$38.69 , N/A ,$79.05 , N/A ,$26.04 ,$83.70 ,$55.95 , N/A ,$60.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$127.00 ,$82.55 ,$35.56 ,$127.00 ,$82.55 , N/A ,$35.56 ,$64.26 , N/A ,$73.03 , N/A ,$64.25 , N/A , N/A ,$104.14 , N/A , N/A ,$107.95 ,$114.30 , N/A ,$95.25 ,$88.90 ,$93.98 ,$93.98 , N/A ,$107.95 , N/A , N/A ,$89.03 , N/A ,$52.83 , N/A ,$107.95 , N/A ,$35.56 ,$114.30 ,$127.00 , N/A ,$82.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$2,349.00 ","$1,526.85 ",$107.33 ,"$2,349.00 ","$1,526.85 ",$107.33 ,$657.72 ,"$1,188.59 ",$107.33 ,"$1,350.68 ",$107.33 ,"$1,188.36 ",$107.33 ,$203.93 ,"$1,926.18 ",$268.33 ,$107.33 ,"$1,996.65 ","$2,114.10 ",$107.33 ,"$1,761.75 ","$1,644.30 ","$1,738.26 ","$1,738.26 ",$268.33 ,"$1,996.65 ",$107.33 ,$107.33 ,"$1,646.65 ",$107.33 ,$977.18 , N/A ,"$1,996.65 ",$230.77 ,$657.72 ,"$2,114.10 ",$775.00 ,$107.33 ,"$1,526.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,959.00 ","$1,923.35 ",$176.10 ,"$2,959.00 ","$1,923.35 ",$176.10 ,$828.52 ,"$1,497.25 ",$176.10 ,"$1,701.43 ",$176.10 ,"$1,496.96 ",$176.10 ,$334.60 ,"$2,426.38 ",$440.26 ,$176.10 ,"$2,515.15 ","$2,663.10 ",$176.10 ,"$2,219.25 ","$2,071.30 ","$2,189.66 ","$2,189.66 ",$440.26 ,"$2,515.15 ",$176.10 ,$176.10 ,"$2,074.26 ",$176.10 ,"$1,230.94 ", N/A ,"$2,515.15 ",$378.62 ,$828.52 ,"$2,663.10 ",$775.00 ,$176.10 ,"$1,923.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$3,324.00 ","$2,160.60 ",$176.10 ,"$3,324.00 ","$2,160.60 ",$176.10 ,$930.72 ,"$1,681.94 ",$176.10 ,"$1,911.30 ",$176.10 ,"$1,681.61 ",$176.10 ,$334.60 ,"$2,725.68 ",$440.26 ,$176.10 ,"$2,825.40 ","$2,991.60 ",$176.10 ,"$2,493.00 ","$2,326.80 ","$2,459.76 ","$2,459.76 ",$440.26 ,"$2,825.40 ",$176.10 ,$176.10 ,"$2,330.12 ",$176.10 ,"$1,382.78 ", N/A ,"$2,825.40 ",$378.62 ,$930.72 ,"$2,991.60 ",$775.00 ,$176.10 ,"$2,160.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$2,242.00 ","$1,457.30 ",$107.33 ,"$2,242.00 ","$1,457.30 ",$107.33 ,$627.76 ,"$1,134.45 ",$107.33 ,"$1,289.15 ",$107.33 ,"$1,134.23 ",$107.33 ,$203.93 ,"$1,838.44 ",$268.33 ,$107.33 ,"$1,905.70 ","$2,017.80 ",$107.33 ,"$1,681.50 ","$1,569.40 ","$1,659.08 ","$1,659.08 ",$268.33 ,"$1,905.70 ",$107.33 ,$107.33 ,"$1,571.64 ",$107.33 ,$932.67 , N/A ,"$1,905.70 ",$230.77 ,$627.76 ,"$2,017.80 ",$775.00 ,$107.33 ,"$1,457.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,959.00 ","$1,923.35 ",$176.10 ,"$2,959.00 ","$1,923.35 ",$176.10 ,$828.52 ,"$1,497.25 ",$176.10 ,"$1,701.43 ",$176.10 ,"$1,496.96 ",$176.10 ,$334.60 ,"$2,426.38 ",$440.26 ,$176.10 ,"$2,515.15 ","$2,663.10 ",$176.10 ,"$2,219.25 ","$2,071.30 ","$2,189.66 ","$2,189.66 ",$440.26 ,"$2,515.15 ",$176.10 ,$176.10 ,"$2,074.26 ",$176.10 ,"$1,230.94 ", N/A ,"$2,515.15 ",$378.62 ,$828.52 ,"$2,663.10 ",$775.00 ,$176.10 ,"$1,923.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$3,324.00 ","$2,160.60 ",$176.10 ,"$3,324.00 ","$2,160.60 ",$176.10 ,$930.72 ,"$1,681.94 ",$176.10 ,"$1,911.30 ",$176.10 ,"$1,681.61 ",$176.10 ,$334.60 ,"$2,725.68 ",$440.26 ,$176.10 ,"$2,825.40 ","$2,991.60 ",$176.10 ,"$2,493.00 ","$2,326.80 ","$2,459.76 ","$2,459.76 ",$440.26 ,"$2,825.40 ",$176.10 ,$176.10 ,"$2,330.12 ",$176.10 ,"$1,382.78 ", N/A ,"$2,825.40 ",$378.62 ,$930.72 ,"$2,991.60 ",$775.00 ,$176.10 ,"$2,160.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$2,242.00 ","$1,457.30 ",$107.33 ,"$2,242.00 ","$1,457.30 ",$107.33 ,$627.76 ,"$1,134.45 ",$107.33 ,"$1,289.15 ",$107.33 ,"$1,134.23 ",$107.33 ,$203.93 ,"$1,838.44 ",$268.33 ,$107.33 ,"$1,905.70 ","$2,017.80 ",$107.33 ,"$1,681.50 ","$1,569.40 ","$1,659.08 ","$1,659.08 ",$268.33 ,"$1,905.70 ",$107.33 ,$107.33 ,"$1,571.64 ",$107.33 ,$932.67 , N/A ,"$1,905.70 ",$230.77 ,$627.76 ,"$2,017.80 ",$775.00 ,$107.33 ,"$1,457.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$508.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,624.00 ","$1,705.60 ",$176.10 ,"$2,624.00 ","$1,705.60 ",$176.10 ,$734.72 ,"$1,327.74 ",$176.10 ,"$1,508.80 ",$176.10 ,"$1,327.48 ",$176.10 ,$334.60 ,"$2,151.68 ",$440.26 ,$176.10 ,"$2,230.40 ","$2,361.60 ",$176.10 ,"$1,968.00 ","$1,836.80 ","$1,941.76 ","$1,941.76 ",$440.26 ,"$2,230.40 ",$176.10 ,$176.10 ,"$1,839.42 ",$176.10 ,"$1,091.58 ", N/A ,"$2,230.40 ",$378.62 ,$734.72 ,"$2,361.60 ",$775.00 ,$176.10 ,"$1,705.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$2,140.00 ","$1,391.00 ",$107.33 ,"$2,140.00 ","$1,391.00 ",$107.33 ,$599.20 ,"$1,082.84 ",$107.33 ,"$1,230.50 ",$107.33 ,"$1,082.63 ",$107.33 ,$203.93 ,"$1,754.80 ",$268.33 ,$107.33 ,"$1,819.00 ","$1,926.00 ",$107.33 ,"$1,605.00 ","$1,498.00 ","$1,583.60 ","$1,583.60 ",$268.33 ,"$1,819.00 ",$107.33 ,$107.33 ,"$1,500.14 ",$107.33 ,$890.24 , N/A ,"$1,819.00 ",$230.77 ,$599.20 ,"$1,926.00 ",$775.00 ,$107.33 ,"$1,391.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,959.00 ","$1,923.35 ",$176.10 ,"$2,959.00 ","$1,923.35 ",$176.10 ,$828.52 ,"$1,497.25 ",$176.10 ,"$1,701.43 ",$176.10 ,"$1,496.96 ",$176.10 ,$334.60 ,"$2,426.38 ",$440.26 ,$176.10 ,"$2,515.15 ","$2,663.10 ",$176.10 ,"$2,219.25 ","$2,071.30 ","$2,189.66 ","$2,189.66 ",$440.26 ,"$2,515.15 ",$176.10 ,$176.10 ,"$2,074.26 ",$176.10 ,"$1,230.94 ", N/A ,"$2,515.15 ",$378.62 ,$828.52 ,"$2,663.10 ",$775.00 ,$176.10 ,"$1,923.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$3,324.00 ","$2,160.60 ",$176.10 ,"$3,324.00 ","$2,160.60 ",$176.10 ,$930.72 ,"$1,681.94 ",$176.10 ,"$1,911.30 ",$176.10 ,"$1,681.61 ",$176.10 ,$334.60 ,"$2,725.68 ",$440.26 ,$176.10 ,"$2,825.40 ","$2,991.60 ",$176.10 ,"$2,493.00 ","$2,326.80 ","$2,459.76 ","$2,459.76 ",$440.26 ,"$2,825.40 ",$176.10 ,$176.10 ,"$2,330.12 ",$176.10 ,"$1,382.78 ", N/A ,"$2,825.40 ",$378.62 ,$930.72 ,"$2,991.60 ",$775.00 ,$176.10 ,"$2,160.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$3,392.00 ","$2,204.80 ",$176.10 ,"$3,392.00 ","$2,204.80 ",$176.10 ,$949.76 ,"$1,716.35 ",$176.10 ,"$1,950.40 ",$176.10 ,"$1,716.01 ",$176.10 ,$334.60 ,"$2,781.44 ",$440.26 ,$176.10 ,"$2,883.20 ","$3,052.80 ",$176.10 ,"$2,544.00 ","$2,374.40 ","$2,510.08 ","$2,510.08 ",$440.26 ,"$2,883.20 ",$176.10 ,$176.10 ,"$2,377.79 ",$176.10 ,"$1,411.07 ", N/A ,"$2,883.20 ",$378.62 ,$949.76 ,"$3,052.80 ",$775.00 ,$176.10 ,"$2,204.80 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$3,392.00 ","$2,204.80 ",$176.10 ,"$3,392.00 ","$2,204.80 ",$176.10 ,$949.76 ,"$1,716.35 ",$176.10 ,"$1,950.40 ",$176.10 ,"$1,716.01 ",$176.10 ,$334.60 ,"$2,781.44 ",$440.26 ,$176.10 ,"$2,883.20 ","$3,052.80 ",$176.10 ,"$2,544.00 ","$2,374.40 ","$2,510.08 ","$2,510.08 ",$440.26 ,"$2,883.20 ",$176.10 ,$176.10 ,"$2,377.79 ",$176.10 ,"$1,411.07 ", N/A ,"$2,883.20 ",$378.62 ,$949.76 ,"$3,052.80 ",$775.00 ,$176.10 ,"$2,204.80 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,339.00 ","$2,170.35 ",$226.85 ,"$3,339.00 ","$2,170.35 ",$226.85 ,$934.92 ,"$1,689.53 ",$226.85 ,"$1,919.93 ",$226.85 ,"$1,689.20 ",$226.85 ,$431.02 ,"$2,737.98 ",$567.13 ,$226.85 ,"$2,838.15 ","$3,005.10 ",$226.85 ,"$2,504.25 ","$2,337.30 ","$2,470.86 ","$2,470.86 ",$567.13 ,"$2,838.15 ",$226.85 ,$226.85 ,"$2,340.64 ",$226.85 ,"$1,389.02 ", N/A ,"$2,838.15 ",$487.73 ,$934.92 ,"$3,005.10 ","$1,400.00 ",$226.85 ,"$2,170.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$3,029.00 ","$1,968.85 ",$107.33 ,"$3,029.00 ","$1,968.85 ",$107.33 ,$848.12 ,"$1,532.67 ",$107.33 ,"$1,741.68 ",$107.33 ,"$1,532.37 ",$107.33 ,$203.93 ,"$2,483.78 ",$268.33 ,$107.33 ,"$2,574.65 ","$2,726.10 ",$107.33 ,"$2,271.75 ","$2,120.30 ","$2,241.46 ","$2,241.46 ",$268.33 ,"$2,574.65 ",$107.33 ,$107.33 ,"$2,123.33 ",$107.33 ,"$1,260.06 ", N/A ,"$2,574.65 ",$230.77 ,$848.12 ,"$2,726.10 ",$775.00 ,$107.33 ,"$1,968.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$508.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$2,788.00 ","$1,812.20 ",$107.33 ,"$2,788.00 ","$1,812.20 ",$107.33 ,$780.64 ,"$1,410.73 ",$107.33 ,"$1,603.10 ",$107.33 ,"$1,410.45 ",$107.33 ,$203.93 ,"$2,286.16 ",$268.33 ,$107.33 ,"$2,369.80 ","$2,509.20 ",$107.33 ,"$2,091.00 ","$1,951.60 ","$2,063.12 ","$2,063.12 ",$268.33 ,"$2,369.80 ",$107.33 ,$107.33 ,"$1,954.39 ",$107.33 ,"$1,159.81 ", N/A ,"$2,369.80 ",$230.77 ,$780.64 ,"$2,509.20 ",$775.00 ,$107.33 ,"$1,812.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$508.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$508.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$2,788.00 ","$1,812.20 ",$107.33 ,"$2,788.00 ","$1,812.20 ",$107.33 ,$780.64 ,"$1,410.73 ",$107.33 ,"$1,603.10 ",$107.33 ,"$1,410.45 ",$107.33 ,$203.93 ,"$2,286.16 ",$268.33 ,$107.33 ,"$2,369.80 ","$2,509.20 ",$107.33 ,"$2,091.00 ","$1,951.60 ","$2,063.12 ","$2,063.12 ",$268.33 ,"$2,369.80 ",$107.33 ,$107.33 ,"$1,954.39 ",$107.33 ,"$1,159.81 ", N/A ,"$2,369.80 ",$230.77 ,$780.64 ,"$2,509.20 ",$775.00 ,$107.33 ,"$1,812.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$3,814.00 ","$2,479.10 ",$363.05 ,"$3,814.00 ","$2,479.10 ",$363.05 ,"$1,067.92 ","$1,929.88 ",$363.05 ,"$2,193.05 ",$363.05 ,"$1,929.50 ",$363.05 ,$689.79 ,"$3,127.48 ",$907.62 ,$363.05 ,"$3,241.90 ","$3,432.60 ",$363.05 ,"$2,860.50 ","$2,669.80 ","$2,822.36 ","$2,822.36 ",$907.62 ,"$3,241.90 ",$363.05 ,$363.05 ,"$2,673.61 ",$363.05 ,"$1,586.62 ", N/A ,"$3,241.90 ",$780.55 ,"$1,067.92 ","$3,432.60 ",$775.00 ,$363.05 ,"$2,479.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$3,172.00 ","$2,061.80 ",$176.10 ,"$3,172.00 ","$2,061.80 ",$176.10 ,$888.16 ,"$1,605.03 ",$176.10 ,"$1,823.90 ",$176.10 ,"$1,604.71 ",$176.10 ,$334.60 ,"$2,601.04 ",$440.26 ,$176.10 ,"$2,696.20 ","$2,854.80 ",$176.10 ,"$2,379.00 ","$2,220.40 ","$2,347.28 ","$2,347.28 ",$440.26 ,"$2,696.20 ",$176.10 ,$176.10 ,"$2,223.57 ",$176.10 ,"$1,319.55 ", N/A ,"$2,696.20 ",$378.62 ,$888.16 ,"$2,854.80 ",$775.00 ,$176.10 ,"$2,061.80 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$2,795.00 ","$1,816.75 ",$176.10 ,"$2,795.00 ","$1,816.75 ",$176.10 ,$782.60 ,"$1,414.27 ",$176.10 ,"$1,607.13 ",$176.10 ,"$1,413.99 ",$176.10 ,$334.60 ,"$2,291.90 ",$440.26 ,$176.10 ,"$2,375.75 ","$2,515.50 ",$176.10 ,"$2,096.25 ","$1,956.50 ","$2,068.30 ","$2,068.30 ",$440.26 ,"$2,375.75 ",$176.10 ,$176.10 ,"$1,959.30 ",$176.10 ,"$1,162.72 ", N/A ,"$2,375.75 ",$378.62 ,$782.60 ,"$2,515.50 ",$775.00 ,$176.10 ,"$1,816.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$2,128.00 ","$1,383.20 ",$107.33 ,"$2,128.00 ","$1,383.20 ",$107.33 ,$595.84 ,"$1,076.77 ",$107.33 ,"$1,223.60 ",$107.33 ,"$1,076.56 ",$107.33 ,$203.93 ,"$1,744.96 ",$268.33 ,$107.33 ,"$1,808.80 ","$1,915.20 ",$107.33 ,"$1,596.00 ","$1,489.60 ","$1,574.72 ","$1,574.72 ",$268.33 ,"$1,808.80 ",$107.33 ,$107.33 ,"$1,491.73 ",$107.33 ,$885.25 , N/A ,"$1,808.80 ",$230.77 ,$595.84 ,"$1,915.20 ",$775.00 ,$107.33 ,"$1,383.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,699.00 ","$1,754.35 ",$176.10 ,"$2,699.00 ","$1,754.35 ",$176.10 ,$755.72 ,"$1,365.69 ",$176.10 ,"$1,551.93 ",$176.10 ,"$1,365.42 ",$176.10 ,$334.60 ,"$2,213.18 ",$440.26 ,$176.10 ,"$2,294.15 ","$2,429.10 ",$176.10 ,"$2,024.25 ","$1,889.30 ","$1,997.26 ","$1,997.26 ",$440.26 ,"$2,294.15 ",$176.10 ,$176.10 ,"$1,892.00 ",$176.10 ,"$1,122.78 ", N/A ,"$2,294.15 ",$378.62 ,$755.72 ,"$2,429.10 ",$775.00 ,$176.10 ,"$1,754.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$3,031.00 ","$1,970.15 ",$176.10 ,"$3,031.00 ","$1,970.15 ",$176.10 ,$848.68 ,"$1,533.69 ",$176.10 ,"$1,742.83 ",$176.10 ,"$1,533.38 ",$176.10 ,$334.60 ,"$2,485.42 ",$440.26 ,$176.10 ,"$2,576.35 ","$2,727.90 ",$176.10 ,"$2,273.25 ","$2,121.70 ","$2,242.94 ","$2,242.94 ",$440.26 ,"$2,576.35 ",$176.10 ,$176.10 ,"$2,124.73 ",$176.10 ,"$1,260.90 ", N/A ,"$2,576.35 ",$378.62 ,$848.68 ,"$2,727.90 ",$775.00 ,$176.10 ,"$1,970.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$2,045.00 ","$1,329.25 ",$107.33 ,"$2,045.00 ","$1,329.25 ",$107.33 ,$572.60 ,"$1,034.77 ",$107.33 ,"$1,175.88 ",$107.33 ,"$1,034.57 ",$107.33 ,$203.93 ,"$1,676.90 ",$268.33 ,$107.33 ,"$1,738.25 ","$1,840.50 ",$107.33 ,"$1,533.75 ","$1,431.50 ","$1,513.30 ","$1,513.30 ",$268.33 ,"$1,738.25 ",$107.33 ,$107.33 ,"$1,433.55 ",$107.33 ,$850.72 , N/A ,"$1,738.25 ",$230.77 ,$572.60 ,"$1,840.50 ",$775.00 ,$107.33 ,"$1,329.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,825.00 ","$1,836.25 ",$363.05 ,"$2,825.00 ","$1,836.25 ",$363.05 ,$791.00 ,"$1,429.45 ",$363.05 ,"$1,624.38 ",$363.05 ,"$1,429.17 ",$363.05 ,$689.79 ,"$2,316.50 ",$907.62 ,$363.05 ,"$2,401.25 ","$2,542.50 ",$363.05 ,"$2,118.75 ","$1,977.50 ","$2,090.50 ","$2,090.50 ",$907.62 ,"$2,401.25 ",$363.05 ,$363.05 ,"$1,980.33 ",$363.05 ,"$1,175.20 ", N/A ,"$2,401.25 ",$780.55 ,$791.00 ,"$2,542.50 ",$775.00 ,$363.05 ,"$1,836.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$3,173.00 ","$2,062.45 ",$176.10 ,"$3,173.00 ","$2,062.45 ",$176.10 ,$888.44 ,"$1,605.54 ",$176.10 ,"$1,824.48 ",$176.10 ,"$1,605.22 ",$176.10 ,$334.60 ,"$2,601.86 ",$440.26 ,$176.10 ,"$2,697.05 ","$2,855.70 ",$176.10 ,"$2,379.75 ","$2,221.10 ","$2,348.02 ","$2,348.02 ",$440.26 ,"$2,697.05 ",$176.10 ,$176.10 ,"$2,224.27 ",$176.10 ,"$1,319.97 ", N/A ,"$2,697.05 ",$378.62 ,$888.44 ,"$2,855.70 ",$775.00 ,$176.10 ,"$2,062.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$3,241.00 ","$2,106.65 ",$176.10 ,"$3,241.00 ","$2,106.65 ",$176.10 ,$907.48 ,"$1,639.95 ",$176.10 ,"$1,863.58 ",$176.10 ,"$1,639.62 ",$176.10 ,$334.60 ,"$2,657.62 ",$440.26 ,$176.10 ,"$2,754.85 ","$2,916.90 ",$176.10 ,"$2,430.75 ","$2,268.70 ","$2,398.34 ","$2,398.34 ",$440.26 ,"$2,754.85 ",$176.10 ,$176.10 ,"$2,271.94 ",$176.10 ,"$1,348.26 ", N/A ,"$2,754.85 ",$378.62 ,$907.48 ,"$2,916.90 ",$775.00 ,$176.10 ,"$2,106.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$2,045.00 ","$1,329.25 ",$107.33 ,"$2,045.00 ","$1,329.25 ",$107.33 ,$572.60 ,"$1,034.77 ",$107.33 ,"$1,175.88 ",$107.33 ,"$1,034.57 ",$107.33 ,$203.93 ,"$1,676.90 ",$268.33 ,$107.33 ,"$1,738.25 ","$1,840.50 ",$107.33 ,"$1,533.75 ","$1,431.50 ","$1,513.30 ","$1,513.30 ",$268.33 ,"$1,738.25 ",$107.33 ,$107.33 ,"$1,433.55 ",$107.33 ,$850.72 , N/A ,"$1,738.25 ",$230.77 ,$572.60 ,"$1,840.50 ",$775.00 ,$107.33 ,"$1,329.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,825.00 ","$1,836.25 ",$176.10 ,"$2,825.00 ","$1,836.25 ",$176.10 ,$791.00 ,"$1,429.45 ",$176.10 ,"$1,624.38 ",$176.10 ,"$1,429.17 ",$176.10 ,$334.60 ,"$2,316.50 ",$440.26 ,$176.10 ,"$2,401.25 ","$2,542.50 ",$176.10 ,"$2,118.75 ","$1,977.50 ","$2,090.50 ","$2,090.50 ",$440.26 ,"$2,401.25 ",$176.10 ,$176.10 ,"$1,980.33 ",$176.10 ,"$1,175.20 ", N/A ,"$2,401.25 ",$378.62 ,$791.00 ,"$2,542.50 ",$775.00 ,$176.10 ,"$1,836.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$3,173.00 ","$2,062.45 ",$176.10 ,"$3,173.00 ","$2,062.45 ",$176.10 ,$888.44 ,"$1,605.54 ",$176.10 ,"$1,824.48 ",$176.10 ,"$1,605.22 ",$176.10 ,$334.60 ,"$2,601.86 ",$440.26 ,$176.10 ,"$2,697.05 ","$2,855.70 ",$176.10 ,"$2,379.75 ","$2,221.10 ","$2,348.02 ","$2,348.02 ",$440.26 ,"$2,697.05 ",$176.10 ,$176.10 ,"$2,224.27 ",$176.10 ,"$1,319.97 ", N/A ,"$2,697.05 ",$378.62 ,$888.44 ,"$2,855.70 ",$775.00 ,$176.10 ,"$2,062.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$3,241.00 ","$2,106.65 ",$176.10 ,"$3,241.00 ","$2,106.65 ",$176.10 ,$907.48 ,"$1,639.95 ",$176.10 ,"$1,863.58 ",$176.10 ,"$1,639.62 ",$176.10 ,$334.60 ,"$2,657.62 ",$440.26 ,$176.10 ,"$2,754.85 ","$2,916.90 ",$176.10 ,"$2,430.75 ","$2,268.70 ","$2,398.34 ","$2,398.34 ",$440.26 ,"$2,754.85 ",$176.10 ,$176.10 ,"$2,271.94 ",$176.10 ,"$1,348.26 ", N/A ,"$2,754.85 ",$378.62 ,$907.48 ,"$2,916.90 ",$775.00 ,$176.10 ,"$2,106.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$2,229.00 ","$1,448.85 ",$107.33 ,"$2,229.00 ","$1,448.85 ",$107.33 ,$624.12 ,"$1,127.87 ",$107.33 ,"$1,281.68 ",$107.33 ,"$1,127.65 ",$107.33 ,$203.93 ,"$1,827.78 ",$268.33 ,$107.33 ,"$1,894.65 ","$2,006.10 ",$107.33 ,"$1,671.75 ","$1,560.30 ","$1,649.46 ","$1,649.46 ",$268.33 ,"$1,894.65 ",$107.33 ,$107.33 ,"$1,562.53 ",$107.33 ,$927.26 , N/A ,"$1,894.65 ",$230.77 ,$624.12 ,"$2,006.10 ",$775.00 ,$107.33 ,"$1,448.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$2,825.00 ","$1,836.25 ",$176.10 ,"$2,825.00 ","$1,836.25 ",$176.10 ,$791.00 ,"$1,429.45 ",$176.10 ,"$1,624.38 ",$176.10 ,"$1,429.17 ",$176.10 ,$334.60 ,"$2,316.50 ",$440.26 ,$176.10 ,"$2,401.25 ","$2,542.50 ",$176.10 ,"$2,118.75 ","$1,977.50 ","$2,090.50 ","$2,090.50 ",$440.26 ,"$2,401.25 ",$176.10 ,$176.10 ,"$1,980.33 ",$176.10 ,"$1,175.20 ", N/A ,"$2,401.25 ",$378.62 ,$791.00 ,"$2,542.50 ",$775.00 ,$176.10 ,"$1,836.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,173.00 ","$2,062.45 ",$176.10 ,"$3,173.00 ","$2,062.45 ",$176.10 ,$888.44 ,"$1,605.54 ",$176.10 ,"$1,824.48 ",$176.10 ,"$1,605.22 ",$176.10 ,$334.60 ,"$2,601.86 ",$440.26 ,$176.10 ,"$2,697.05 ","$2,855.70 ",$176.10 ,"$2,379.75 ","$2,221.10 ","$2,348.02 ","$2,348.02 ",$440.26 ,"$2,697.05 ",$176.10 ,$176.10 ,"$2,224.27 ",$176.10 ,"$1,319.97 ", N/A ,"$2,697.05 ",$378.62 ,$888.44 ,"$2,855.70 ",$775.00 ,$176.10 ,"$2,062.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,795.00 ","$1,816.75 ",$176.10 ,"$2,795.00 ","$1,816.75 ",$176.10 ,$782.60 ,"$1,414.27 ",$176.10 ,"$1,607.13 ",$176.10 ,"$1,413.99 ",$176.10 ,$334.60 ,"$2,291.90 ",$440.26 ,$176.10 ,"$2,375.75 ","$2,515.50 ",$176.10 ,"$2,096.25 ","$1,956.50 ","$2,068.30 ","$2,068.30 ",$440.26 ,"$2,375.75 ",$176.10 ,$176.10 ,"$1,959.30 ",$176.10 ,"$1,162.72 ", N/A ,"$2,375.75 ",$378.62 ,$782.60 ,"$2,515.50 ",$775.00 ,$176.10 ,"$1,816.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$4,787.00 ","$3,111.55 ",$226.85 ,"$4,787.00 ","$3,111.55 ",$226.85 ,"$1,340.36 ","$2,422.22 ",$226.85 ,"$2,752.53 ",$226.85 ,"$2,421.74 ",$226.85 ,$431.02 ,"$3,925.34 ",$567.13 ,$226.85 ,"$4,068.95 ","$4,308.30 ",$226.85 ,"$3,590.25 ","$3,350.90 ","$3,542.38 ","$3,542.38 ",$567.13 ,"$4,068.95 ",$226.85 ,$226.85 ,"$3,355.69 ",$226.85 ,"$1,991.39 ", N/A ,"$4,068.95 ",$487.73 ,"$1,340.36 ","$4,308.30 ",$775.00 ,$226.85 ,"$3,111.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$5,762.00 ","$3,745.30 ",$363.05 ,"$5,762.00 ","$3,745.30 ",$363.05 ,"$1,613.36 ","$2,915.57 ",$363.05 ,"$3,313.15 ",$363.05 ,"$2,915.00 ",$363.05 ,$689.79 ,"$4,724.84 ",$907.62 ,$363.05 ,"$4,897.70 ","$5,185.80 ",$363.05 ,"$4,321.50 ","$4,033.40 ","$4,263.88 ","$4,263.88 ",$907.62 ,"$4,897.70 ",$363.05 ,$363.05 ,"$4,039.16 ",$363.05 ,"$2,396.99 ", N/A ,"$4,897.70 ",$780.55 ,"$1,613.36 ","$5,185.80 ",$775.00 ,$363.05 ,"$3,745.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$6,499.00 ","$4,224.35 ",$363.05 ,"$6,499.00 ","$4,224.35 ",$363.05 ,"$1,819.72 ","$3,288.49 ",$363.05 ,"$3,736.93 ",$363.05 ,"$3,287.84 ",$363.05 ,$689.79 ,"$5,329.18 ",$907.62 ,$363.05 ,"$5,524.15 ","$5,849.10 ",$363.05 ,"$4,874.25 ","$4,549.30 ","$4,809.26 ","$4,809.26 ",$907.62 ,"$5,524.15 ",$363.05 ,$363.05 ,"$4,555.80 ",$363.05 ,"$2,703.58 ", N/A ,"$5,524.15 ",$780.55 ,"$1,819.72 ","$5,849.10 ",$775.00 ,$363.05 ,"$4,224.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,$151.00 ,$98.15 ,$42.28 ,$199.36 ,$98.15 ,$79.75 ,$42.28 ,$76.41 ,$79.75 ,$86.83 ,$79.75 ,$76.39 ,$79.75 ,$151.00 ,$123.82 ,$199.36 ,$79.75 ,$128.35 ,$135.90 ,$79.75 ,$113.25 ,$105.70 ,$111.74 ,$111.74 ,$151.00 ,$128.35 ,$79.75 ,$79.75 ,$105.85 ,$79.75 ,$62.82 , N/A ,$128.35 ,$171.45 ,$42.28 ,$135.90 ,$151.00 ,$79.75 ,$98.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000088,N/A,HC CT HRT W/O DYE W/CA TEST (PROMO),350,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 ,$25.35 , N/A ,$10.92 ,$19.73 , N/A ,$22.43 , N/A ,$19.73 , N/A , N/A ,$31.98 , N/A , N/A ,$33.15 ,$35.10 , N/A ,$29.25 ,$27.30 ,$28.86 ,$28.86 , N/A ,$33.15 , N/A , N/A ,$27.34 , N/A ,$16.22 , N/A ,$33.15 , N/A ,$10.92 ,$35.10 ,$39.00 , N/A ,$25.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000089,75572,HC CT HEART WO/W CONT FUNCT EVAL,350,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$508.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000094,75574,HC CTA HEART CORONARY W/CONTRAST 3D POST,350,1 ,$508.00 ,$330.20 ,$142.24 ,$508.00 ,$330.20 ,$176.10 ,$142.24 ,$257.05 ,$176.10 ,$292.10 ,$176.10 ,$257.00 ,$176.10 ,$334.60 ,$416.56 ,$440.26 ,$176.10 ,$431.80 ,$457.20 ,$176.10 ,$381.00 ,$355.60 ,$375.92 ,$375.92 ,$440.26 ,$431.80 ,$176.10 ,$176.10 ,$356.11 ,$176.10 ,$211.33 , N/A ,$431.80 ,$378.62 ,$142.24 ,$457.20 ,$508.00 ,$176.10 ,$330.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$3,241.00 ","$2,106.65 ",$176.10 ,"$3,241.00 ","$2,106.65 ",$176.10 ,$907.48 ,"$1,639.95 ",$176.10 ,"$1,863.58 ",$176.10 ,"$1,639.62 ",$176.10 ,$334.60 ,"$2,657.62 ",$440.26 ,$176.10 ,"$2,754.85 ","$2,916.90 ",$176.10 ,"$2,430.75 ","$2,268.70 ","$2,398.34 ","$2,398.34 ",$440.26 ,"$2,754.85 ",$176.10 ,$176.10 ,"$2,271.94 ",$176.10 ,"$1,348.26 ", N/A ,"$2,754.85 ",$378.62 ,$907.48 ,"$2,916.90 ",$775.00 ,$176.10 ,"$2,106.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000100,76377,HC 3D RENDER CT REQUIRES INDEPENDENT,350,1 ,"$1,023.00 ",$664.95 ,$286.44 ,"$1,023.00 ",$664.95 , N/A ,$286.44 ,$517.64 , N/A ,$588.23 , N/A ,$517.54 , N/A , N/A ,$838.86 , N/A , N/A ,$869.55 ,$920.70 , N/A ,$767.25 ,$716.10 ,$757.02 ,$757.02 , N/A ,$869.55 , N/A , N/A ,$717.12 , N/A ,$425.57 , N/A ,$869.55 , N/A ,$286.44 ,$920.70 ,$775.00 , N/A ,$664.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$1,926.00 ","$1,251.90 ",$539.28 ,"$1,926.00 ","$1,251.90 ", N/A ,$539.28 ,$974.56 , N/A ,"$1,107.45 ", N/A ,$974.36 , N/A , N/A ,"$1,579.32 ", N/A , N/A ,"$1,637.10 ","$1,733.40 ", N/A ,"$1,444.50 ","$1,348.20 ","$1,425.24 ","$1,425.24 ", N/A ,"$1,637.10 ", N/A , N/A ,"$1,350.13 ", N/A ,$801.22 , N/A ,"$1,637.10 ", N/A ,$539.28 ,"$1,733.40 ",$775.00 , N/A ,"$1,251.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$4,173.00 ","$2,712.45 ",$363.05 ,"$4,173.00 ","$2,712.45 ",$363.05 ,"$1,168.44 ","$2,111.54 ",$363.05 ,"$2,399.48 ",$363.05 ,"$2,111.12 ",$363.05 ,$689.79 ,"$3,421.86 ",$907.62 ,$363.05 ,"$3,547.05 ","$3,755.70 ",$363.05 ,"$3,129.75 ","$2,921.10 ","$3,088.02 ","$3,088.02 ",$907.62 ,"$3,547.05 ",$363.05 ,$363.05 ,"$2,925.27 ",$363.05 ,"$1,735.97 ", N/A ,"$3,547.05 ",$780.55 ,"$1,168.44 ","$3,755.70 ",$775.00 ,$363.05 ,"$2,712.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,$248.00 ,$161.20 ,$69.44 ,$268.33 ,$161.20 ,$107.33 ,$69.44 ,$125.49 ,$107.33 ,$142.60 ,$107.33 ,$125.46 ,$107.33 ,$203.93 ,$203.36 ,$268.33 ,$107.33 ,$210.80 ,$223.20 ,$107.33 ,$186.00 ,$173.60 ,$183.52 ,$183.52 ,$248.00 ,$210.80 ,$107.33 ,$107.33 ,$173.85 ,$107.33 ,$103.17 , N/A ,$210.80 ,$230.77 ,$69.44 ,$223.20 ,$248.00 ,$107.33 ,$161.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,"$4,387.00 ","$2,851.55 ","$1,228.36 ","$4,387.00 ","$2,851.55 ","$1,387.16 ","$1,228.36 ","$2,219.82 ","$1,387.16 ","$2,522.53 ","$1,387.16 ","$2,219.38 ","$1,387.16 ","$2,635.59 ","$3,597.34 ","$3,467.89 ","$1,387.16 ","$3,728.95 ","$3,948.30 ","$1,387.16 ","$3,290.25 ","$3,070.90 ","$3,246.38 ","$3,246.38 ","$3,467.89 ","$3,728.95 ","$1,387.16 ","$1,387.16 ","$3,075.29 ","$1,387.16 ","$1,824.99 ", N/A ,"$3,728.95 ","$2,982.38 ","$1,228.36 ","$3,948.30 ","$2,350.00 ","$1,387.16 ","$2,851.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$507.00 ,$329.55 ,$141.96 ,$851.90 ,$329.55 ,$340.76 ,$141.96 ,$256.54 ,$340.76 ,$291.53 ,$340.76 ,$256.49 ,$340.76 ,$507.00 ,$415.74 ,$851.90 ,$340.76 ,$430.95 ,$456.30 ,$340.76 ,$380.25 ,$354.90 ,$375.18 ,$375.18 ,$507.00 ,$430.95 ,$340.76 ,$340.76 ,$355.41 ,$340.76 ,$210.91 , N/A ,$430.95 ,$732.63 ,$141.96 ,$456.30 ,$250.00 ,$340.76 ,$329.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,283.00 ","$2,783.95 ","$1,199.24 ","$4,283.00 ","$2,783.95 ","$1,387.16 ","$1,199.24 ","$2,167.20 ","$1,387.16 ","$2,462.73 ","$1,387.16 ","$2,166.77 ","$1,387.16 ","$2,635.59 ","$3,512.06 ","$3,467.89 ","$1,387.16 ","$3,640.55 ","$3,854.70 ","$1,387.16 ","$3,212.25 ","$2,998.10 ","$3,169.42 ","$3,169.42 ","$3,467.89 ","$3,640.55 ","$1,387.16 ","$1,387.16 ","$3,002.38 ","$1,387.16 ","$1,781.73 ", N/A ,"$3,640.55 ","$2,982.38 ","$1,199.24 ","$3,854.70 ","$2,350.00 ","$1,387.16 ","$2,783.95 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,183.00 ",$768.95 ,$331.24 ,"$1,533.75 ",$768.95 ,$613.50 ,$331.24 ,$598.60 ,$613.50 ,$680.23 ,$613.50 ,$598.48 ,$613.50 ,"$1,165.65 ",$970.06 ,"$1,533.75 ",$613.50 ,"$1,005.55 ","$1,064.70 ",$613.50 ,$887.25 ,$828.10 ,$875.42 ,$875.42 ,"$1,183.00 ","$1,005.55 ",$613.50 ,$613.50 ,$829.28 ,$613.50 ,$492.13 , N/A ,"$1,005.55 ","$1,319.02 ",$331.24 ,"$1,064.70 ","$1,183.00 ",$613.50 ,$768.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000110,19085,HC BX BREAST 1ST LESION MR IMAG,360,1 ,"$4,088.00 ","$2,657.20 ","$1,144.64 ","$4,088.00 ","$2,657.20 ","$1,387.16 ","$1,144.64 ","$2,068.53 ","$1,387.16 ","$2,350.60 ","$1,387.16 ","$2,068.12 ","$1,387.16 ","$2,635.59 ","$3,352.16 ","$3,467.89 ","$1,387.16 ","$3,474.80 ","$3,679.20 ","$1,387.16 ","$3,066.00 ","$2,861.60 ","$3,025.12 ","$3,025.12 ","$3,467.89 ","$3,474.80 ","$1,387.16 ","$1,387.16 ","$2,865.69 ","$1,387.16 ","$1,700.61 ", N/A ,"$3,474.80 ","$2,982.38 ","$1,144.64 ","$3,679.20 ","$2,350.00 ","$1,387.16 ","$2,657.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000112,19287,HC PERCUTAN DEV BREAST 1ST MR GUIDE,360,1 ,"$1,807.00 ","$1,174.55 ",$505.96 ,"$1,807.00 ","$1,174.55 ",$613.50 ,$505.96 ,$914.34 ,$613.50 ,"$1,039.03 ",$613.50 ,$914.16 ,$613.50 ,"$1,165.65 ","$1,481.74 ","$1,533.75 ",$613.50 ,"$1,535.95 ","$1,626.30 ",$613.50 ,"$1,355.25 ","$1,264.90 ","$1,337.18 ","$1,337.18 ","$1,533.75 ","$1,535.95 ",$613.50 ,$613.50 ,"$1,266.71 ",$613.50 ,$751.71 , N/A ,"$1,535.95 ","$1,319.02 ",$505.96 ,"$1,626.30 ","$1,750.00 ",$613.50 ,"$1,174.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$3,881.00 ","$2,522.65 ","$1,086.68 ","$7,055.60 ","$2,522.65 ","$2,822.24 ","$1,086.68 ","$1,963.79 ","$2,822.24 ","$2,231.58 ","$2,822.24 ","$1,963.40 ","$2,822.24 ","$3,881.00 ","$3,182.42 ","$7,055.60 ","$2,822.24 ","$3,298.85 ","$3,492.90 ","$2,822.24 ","$2,910.75 ","$2,716.70 ","$2,871.94 ","$2,871.94 ","$3,881.00 ","$3,298.85 ","$2,822.24 ","$2,822.24 ","$2,720.58 ","$2,822.24 ","$1,614.50 ", N/A ,"$3,298.85 ","$6,067.81 ","$1,086.68 ","$3,492.90 ","$1,750.00 ","$2,822.24 ","$2,522.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$8,585.00 ","$5,580.25 ","$2,403.80 ","$8,585.00 ","$5,580.25 ","$2,822.24 ","$2,403.80 ","$4,344.01 ","$2,822.24 ","$4,936.38 ","$2,822.24 ","$4,343.15 ","$2,822.24 ","$5,362.25 ","$7,039.70 ","$7,055.60 ","$2,822.24 ","$7,297.25 ","$7,726.50 ","$2,822.24 ","$6,438.75 ","$6,009.50 ","$6,352.90 ","$6,352.90 ","$7,055.60 ","$7,297.25 ","$2,822.24 ","$2,822.24 ","$6,018.09 ","$2,822.24 ","$3,571.36 ", N/A ,"$7,297.25 ","$6,067.81 ","$2,403.80 ","$7,726.50 ","$3,250.00 ","$2,822.24 ","$5,580.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$1,369.00 ",$889.85 ,$383.32 ,"$3,465.89 ",$889.85 ,"$1,386.35 ",$383.32 ,$692.71 ,"$1,386.35 ",$787.18 ,"$1,369.00 ",$692.58 ,"$1,369.00 ","$1,369.00 ","$1,122.58 ","$3,465.89 ","$1,386.35 ","$1,163.65 ","$1,232.10 ","$1,386.35 ","$1,026.75 ",$958.30 ,"$1,013.06 ","$1,013.06 ","$1,369.00 ","$1,163.65 ","$1,386.35 ","$1,386.35 ",$959.67 ,"$1,386.35 ",$569.50 , N/A ,"$1,163.65 ","$2,980.66 ",$383.32 ,"$1,232.10 ","$1,369.00 ","$1,386.35 ",$889.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,"$1,074.00 ",$698.10 ,$250.00 ,"$1,074.00 ",$698.10 ,$371.64 ,$300.72 ,$543.44 ,$371.64 ,$617.55 ,$371.64 ,$543.34 ,$371.64 ,$706.11 ,$880.68 ,$929.10 ,$371.64 ,$912.90 ,$966.60 ,$371.64 ,$805.50 ,$751.80 ,$794.76 ,$794.76 ,$929.10 ,$912.90 ,$371.64 ,$371.64 ,$752.87 ,$371.64 ,$446.78 , N/A ,$912.90 ,$799.02 ,$300.72 ,$966.60 ,$250.00 ,$371.64 ,$698.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,869.00 ","$1,214.85 ",$523.32 ,"$1,869.00 ","$1,214.85 ",$626.03 ,$523.32 ,$945.71 ,$626.03 ,"$1,074.68 ",$626.03 ,$945.53 ,$626.03 ,"$1,189.46 ","$1,532.58 ","$1,565.07 ",$626.03 ,"$1,588.65 ","$1,682.10 ",$626.03 ,"$1,401.75 ","$1,308.30 ","$1,383.06 ","$1,383.06 ","$1,565.07 ","$1,588.65 ",$626.03 ,$626.03 ,"$1,310.17 ",$626.03 ,$777.50 , N/A ,"$1,588.65 ","$1,345.96 ",$523.32 ,"$1,682.10 ","$1,750.00 ",$626.03 ,"$1,214.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36000546,11750,HC REMOVE NAIL BED,360,1 ,"$1,518.00 ",$986.70 ,$250.00 ,"$1,518.00 ",$986.70 ,$340.76 ,$425.04 ,$768.11 ,$340.76 ,$872.85 ,$340.76 ,$767.96 ,$340.76 ,$647.44 ,"$1,244.76 ",$851.90 ,$340.76 ,"$1,290.30 ","$1,366.20 ",$340.76 ,"$1,138.50 ","$1,062.60 ","$1,123.32 ","$1,123.32 ",$851.90 ,"$1,290.30 ",$340.76 ,$340.76 ,"$1,064.12 ",$340.76 ,$631.49 , N/A ,"$1,290.30 ",$732.63 ,$425.04 ,"$1,366.20 ",$250.00 ,$340.76 ,$986.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060014,N/A,HC OR LEVEL 1 ADDL 15MIN,360,1 ,$797.00 ,$518.05 ,$223.16 ,$797.00 ,$518.05 , N/A ,$223.16 ,$403.28 , N/A ,$458.28 , N/A ,$403.20 , N/A , N/A ,$653.54 , N/A , N/A ,$677.45 ,$717.30 , N/A ,$597.75 ,$557.90 ,$589.78 ,$589.78 , N/A ,$677.45 , N/A , N/A ,$558.70 , N/A ,$331.55 , N/A ,$677.45 , N/A ,$223.16 ,$717.30 , N/A , N/A ,$518.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060016,N/A,HC OR LEVEL 2 ADDL 15MIN,360,1 ,$908.00 ,$590.20 ,$254.24 ,$908.00 ,$590.20 , N/A ,$254.24 ,$459.45 , N/A ,$522.10 , N/A ,$459.36 , N/A , N/A ,$744.56 , N/A , N/A ,$771.80 ,$817.20 , N/A ,$681.00 ,$635.60 ,$671.92 ,$671.92 , N/A ,$771.80 , N/A , N/A ,$636.51 , N/A ,$377.73 , N/A ,$771.80 , N/A ,$254.24 ,$817.20 , N/A , N/A ,$590.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060018,N/A,HC OR LEVEL 3 ADDL 15MIN,360,1 ,"$1,058.00 ",$687.70 ,$296.24 ,"$1,058.00 ",$687.70 , N/A ,$296.24 ,$535.35 , N/A ,$608.35 , N/A ,$535.24 , N/A , N/A ,$867.56 , N/A , N/A ,$899.30 ,$952.20 , N/A ,$793.50 ,$740.60 ,$782.92 ,$782.92 , N/A ,$899.30 , N/A , N/A ,$741.66 , N/A ,$440.13 , N/A ,$899.30 , N/A ,$296.24 ,$952.20 , N/A , N/A ,$687.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060020,N/A,HC OR LEVEL 4 ADDL 15MIN,360,1 ,"$1,196.00 ",$777.40 ,$334.88 ,"$1,196.00 ",$777.40 , N/A ,$334.88 ,$605.18 , N/A ,$687.70 , N/A ,$605.06 , N/A , N/A ,$980.72 , N/A , N/A ,"$1,016.60 ","$1,076.40 ", N/A ,$897.00 ,$837.20 ,$885.04 ,$885.04 , N/A ,"$1,016.60 ", N/A , N/A ,$838.40 , N/A ,$497.54 , N/A ,"$1,016.60 ", N/A ,$334.88 ,"$1,076.40 ", N/A , N/A ,$777.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060022,N/A,HC OR LEVEL 5 ADDL 15MIN,360,1 ,"$1,333.00 ",$866.45 ,$373.24 ,"$1,333.00 ",$866.45 , N/A ,$373.24 ,$674.50 , N/A ,$766.48 , N/A ,$674.36 , N/A , N/A ,"$1,093.06 ", N/A , N/A ,"$1,133.05 ","$1,199.70 ", N/A ,$999.75 ,$933.10 ,$986.42 ,$986.42 , N/A ,"$1,133.05 ", N/A , N/A ,$934.43 , N/A ,$554.53 , N/A ,"$1,133.05 ", N/A ,$373.24 ,"$1,199.70 ", N/A , N/A ,$866.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060024,N/A,HC OR LEVEL 6 ADDL 15MIN,360,1 ,"$1,444.00 ",$938.60 ,$404.32 ,"$1,444.00 ",$938.60 , N/A ,$404.32 ,$730.66 , N/A ,$830.30 , N/A ,$730.52 , N/A , N/A ,"$1,184.08 ", N/A , N/A ,"$1,227.40 ","$1,299.60 ", N/A ,"$1,083.00 ","$1,010.80 ","$1,068.56 ","$1,068.56 ", N/A ,"$1,227.40 ", N/A , N/A ,"$1,012.24 ", N/A ,$600.70 , N/A ,"$1,227.40 ", N/A ,$404.32 ,"$1,299.60 ", N/A , N/A ,$938.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060025,N/A,HC OR LEVEL 1 INITIAL 30MIN,360,1 ,"$2,459.00 ","$1,598.35 ",$688.52 ,"$2,459.00 ","$1,598.35 ", N/A ,$688.52 ,"$1,244.25 ", N/A ,"$1,413.93 ", N/A ,"$1,244.01 ", N/A , N/A ,"$2,016.38 ", N/A , N/A ,"$2,090.15 ","$2,213.10 ", N/A ,"$1,844.25 ","$1,721.30 ","$1,819.66 ","$1,819.66 ", N/A ,"$2,090.15 ", N/A , N/A ,"$1,723.76 ", N/A ,"$1,022.94 ", N/A ,"$2,090.15 ", N/A ,$688.52 ,"$2,213.10 ", N/A , N/A ,"$1,598.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060026,N/A,HC OR LEVEL 2 INITIAL 30MIN,360,1 ,"$4,234.00 ","$2,752.10 ","$1,185.52 ","$4,234.00 ","$2,752.10 ", N/A ,"$1,185.52 ","$2,142.40 ", N/A ,"$2,434.55 ", N/A ,"$2,141.98 ", N/A , N/A ,"$3,471.88 ", N/A , N/A ,"$3,598.90 ","$3,810.60 ", N/A ,"$3,175.50 ","$2,963.80 ","$3,133.16 ","$3,133.16 ", N/A ,"$3,598.90 ", N/A , N/A ,"$2,968.03 ", N/A ,"$1,761.34 ", N/A ,"$3,598.90 ", N/A ,"$1,185.52 ","$3,810.60 ", N/A , N/A ,"$2,752.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060027,N/A,HC OR LEVEL 3 INITIAL 30MIN,360,1 ,"$5,508.00 ","$3,580.20 ","$1,542.24 ","$5,508.00 ","$3,580.20 ", N/A ,"$1,542.24 ","$2,787.05 ", N/A ,"$3,167.10 ", N/A ,"$2,786.50 ", N/A , N/A ,"$4,516.56 ", N/A , N/A ,"$4,681.80 ","$4,957.20 ", N/A ,"$4,131.00 ","$3,855.60 ","$4,075.92 ","$4,075.92 ", N/A ,"$4,681.80 ", N/A , N/A ,"$3,861.11 ", N/A ,"$2,291.33 ", N/A ,"$4,681.80 ", N/A ,"$1,542.24 ","$4,957.20 ", N/A , N/A ,"$3,580.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060028,N/A,HC OR LEVEL 4 INITIAL 30MIN,360,1 ,"$5,763.00 ","$3,745.95 ","$1,613.64 ","$5,763.00 ","$3,745.95 ", N/A ,"$1,613.64 ","$2,916.08 ", N/A ,"$3,313.73 ", N/A ,"$2,915.50 ", N/A , N/A ,"$4,725.66 ", N/A , N/A ,"$4,898.55 ","$5,186.70 ", N/A ,"$4,322.25 ","$4,034.10 ","$4,264.62 ","$4,264.62 ", N/A ,"$4,898.55 ", N/A , N/A ,"$4,039.86 ", N/A ,"$2,397.41 ", N/A ,"$4,898.55 ", N/A ,"$1,613.64 ","$5,186.70 ", N/A , N/A ,"$3,745.95 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060029,N/A,HC OR LEVEL 5 INITIAL 30MIN,360,1 ,"$6,050.00 ","$3,932.50 ","$1,694.00 ","$6,050.00 ","$3,932.50 ", N/A ,"$1,694.00 ","$3,061.30 ", N/A ,"$3,478.75 ", N/A ,"$3,060.70 ", N/A , N/A ,"$4,961.00 ", N/A , N/A ,"$5,142.50 ","$5,445.00 ", N/A ,"$4,537.50 ","$4,235.00 ","$4,477.00 ","$4,477.00 ", N/A ,"$5,142.50 ", N/A , N/A ,"$4,241.05 ", N/A ,"$2,516.80 ", N/A ,"$5,142.50 ", N/A ,"$1,694.00 ","$5,445.00 ", N/A , N/A ,"$3,932.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36060030,N/A,HC OR LEVEL 6 INITIAL 30MIN,360,1 ,"$7,825.00 ","$5,086.25 ","$2,191.00 ","$7,825.00 ","$5,086.25 ", N/A ,"$2,191.00 ","$3,959.45 ", N/A ,"$4,499.38 ", N/A ,"$3,958.67 ", N/A , N/A ,"$6,416.50 ", N/A , N/A ,"$6,651.25 ","$7,042.50 ", N/A ,"$5,868.75 ","$5,477.50 ","$5,790.50 ","$5,790.50 ", N/A ,"$6,651.25 ", N/A , N/A ,"$5,485.33 ", N/A ,"$3,255.20 ", N/A ,"$6,651.25 ", N/A ,"$2,191.00 ","$7,042.50 ", N/A , N/A ,"$5,086.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$2,342.00 ","$1,522.30 ",$655.76 ,"$2,342.00 ","$1,522.30 ",$811.57 ,$655.76 ,"$1,185.05 ",$811.57 ,"$1,346.65 ",$811.57 ,"$1,184.82 ",$811.57 ,"$1,541.99 ","$1,920.44 ","$2,028.93 ",$811.57 ,"$1,990.70 ","$2,107.80 ",$811.57 ,"$1,756.50 ","$1,639.40 ","$1,733.08 ","$1,733.08 ","$2,028.93 ","$1,990.70 ",$811.57 ,$811.57 ,"$1,641.74 ",$811.57 ,$974.27 , N/A ,"$1,990.70 ","$1,744.88 ",$655.76 ,"$2,107.80 ","$1,750.00 ",$811.57 ,"$1,522.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100043,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-BIL,361,1 ,$887.00 ,$576.55 ,$248.36 ,$965.91 ,$576.55 ,$386.36 ,$248.36 ,$448.82 ,$386.36 ,$510.03 ,$386.36 ,$448.73 ,$386.36 ,$734.09 ,$727.34 ,$965.91 ,$386.36 ,$753.95 ,$798.30 ,$386.36 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$887.00 ,$753.95 ,$386.36 ,$386.36 ,$621.79 ,$386.36 ,$368.99 , N/A ,$753.95 ,$830.68 ,$248.36 ,$798.30 ,$375.00 ,$386.36 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100044,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-BIL,361,1 ,$887.00 ,$576.55 ,$248.36 ,$965.91 ,$576.55 ,$386.36 ,$248.36 ,$448.82 ,$386.36 ,$510.03 ,$386.36 ,$448.73 ,$386.36 ,$734.09 ,$727.34 ,$965.91 ,$386.36 ,$753.95 ,$798.30 ,$386.36 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$887.00 ,$753.95 ,$386.36 ,$386.36 ,$621.79 ,$386.36 ,$368.99 , N/A ,$753.95 ,$830.68 ,$248.36 ,$798.30 ,$375.00 ,$386.36 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100065,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-LT,361,1 ,$887.00 ,$576.55 ,$248.36 ,$887.00 ,$576.55 ,$257.58 ,$248.36 ,$448.82 ,$257.58 ,$510.03 ,$257.58 ,$448.73 ,$257.58 ,$489.39 ,$727.34 ,$643.94 ,$257.58 ,$753.95 ,$798.30 ,$257.58 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$643.94 ,$753.95 ,$257.58 ,$257.58 ,$621.79 ,$257.58 ,$368.99 , N/A ,$753.95 ,$553.79 ,$248.36 ,$798.30 ,$250.00 ,$257.58 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100066,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-RT,361,1 ,$887.00 ,$576.55 ,$248.36 ,$887.00 ,$576.55 ,$257.58 ,$248.36 ,$448.82 ,$257.58 ,$510.03 ,$257.58 ,$448.73 ,$257.58 ,$489.39 ,$727.34 ,$643.94 ,$257.58 ,$753.95 ,$798.30 ,$257.58 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$643.94 ,$753.95 ,$257.58 ,$257.58 ,$621.79 ,$257.58 ,$368.99 , N/A ,$753.95 ,$553.79 ,$248.36 ,$798.30 ,$250.00 ,$257.58 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100067,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,361,1 ,$887.00 ,$576.55 ,$248.36 ,$887.00 ,$576.55 ,$257.58 ,$248.36 ,$448.82 ,$257.58 ,$510.03 ,$257.58 ,$448.73 ,$257.58 ,$489.39 ,$727.34 ,$643.94 ,$257.58 ,$753.95 ,$798.30 ,$257.58 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$643.94 ,$753.95 ,$257.58 ,$257.58 ,$621.79 ,$257.58 ,$368.99 , N/A ,$753.95 ,$553.79 ,$248.36 ,$798.30 ,$250.00 ,$257.58 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100068,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,361,1 ,$887.00 ,$576.55 ,$248.36 ,$887.00 ,$576.55 ,$257.58 ,$248.36 ,$448.82 ,$257.58 ,$510.03 ,$257.58 ,$448.73 ,$257.58 ,$489.39 ,$727.34 ,$643.94 ,$257.58 ,$753.95 ,$798.30 ,$257.58 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$643.94 ,$753.95 ,$257.58 ,$257.58 ,$621.79 ,$257.58 ,$368.99 , N/A ,$753.95 ,$553.79 ,$248.36 ,$798.30 ,$250.00 ,$257.58 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$2,342.00 ","$1,522.30 ",$655.76 ,"$2,342.00 ","$1,522.30 ",$811.57 ,$655.76 ,"$1,185.05 ",$811.57 ,"$1,346.65 ",$811.57 ,"$1,184.82 ",$811.57 ,"$1,541.99 ","$1,920.44 ","$2,028.93 ",$811.57 ,"$1,990.70 ","$2,107.80 ",$811.57 ,"$1,756.50 ","$1,639.40 ","$1,733.08 ","$1,733.08 ","$2,028.93 ","$1,990.70 ",$811.57 ,$811.57 ,"$1,641.74 ",$811.57 ,$974.27 , N/A ,"$1,990.70 ","$1,744.88 ",$655.76 ,"$2,107.80 ","$1,750.00 ",$811.57 ,"$1,522.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100189,64415,HC INTRASCALENE BLOCK SINGLE,361,1 ,"$2,342.00 ","$1,522.30 ",$655.76 ,"$2,342.00 ","$1,522.30 ",$811.57 ,$655.76 ,"$1,185.05 ",$811.57 ,"$1,346.65 ",$811.57 ,"$1,184.82 ",$811.57 ,"$1,541.99 ","$1,920.44 ","$2,028.93 ",$811.57 ,"$1,990.70 ","$2,107.80 ",$811.57 ,"$1,756.50 ","$1,639.40 ","$1,733.08 ","$1,733.08 ","$2,028.93 ","$1,990.70 ",$811.57 ,$811.57 ,"$1,641.74 ",$811.57 ,$974.27 , N/A ,"$1,990.70 ","$1,744.88 ",$655.76 ,"$2,107.80 ","$1,750.00 ",$811.57 ,"$1,522.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100197,64450,HC INJ ANES NERVE PERIPHERAL,361,1 ,"$1,807.00 ","$1,174.55 ",$505.96 ,"$1,807.00 ","$1,174.55 ",$626.03 ,$505.96 ,$914.34 ,$626.03 ,"$1,039.03 ",$626.03 ,$914.16 ,$626.03 ,"$1,189.46 ","$1,481.74 ","$1,565.07 ",$626.03 ,"$1,535.95 ","$1,626.30 ",$626.03 ,"$1,355.25 ","$1,264.90 ","$1,337.18 ","$1,337.18 ","$1,565.07 ","$1,535.95 ",$626.03 ,$626.03 ,"$1,266.71 ",$626.03 ,$751.71 , N/A ,"$1,535.95 ","$1,345.96 ",$505.96 ,"$1,626.30 ","$1,750.00 ",$626.03 ,"$1,174.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100226,58345,HC TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING,361,1 ,"$7,470.00 ","$4,855.50 ","$2,091.60 ","$7,470.00 ","$4,855.50 ","$2,586.63 ","$2,091.60 ","$3,779.82 ","$2,586.63 ","$4,295.25 ","$2,586.63 ","$3,779.07 ","$2,586.63 ","$4,914.60 ","$6,125.40 ","$6,466.58 ","$2,586.63 ","$6,349.50 ","$6,723.00 ","$2,586.63 ","$5,602.50 ","$5,229.00 ","$5,527.80 ","$5,527.80 ","$6,466.58 ","$6,349.50 ","$2,586.63 ","$2,586.63 ","$5,236.47 ","$2,586.63 ","$3,107.52 ", N/A ,"$6,349.50 ","$5,561.26 ","$2,091.60 ","$6,723.00 ","$2,850.00 ","$2,586.63 ","$4,855.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$2,707.00 ","$1,759.55 ",$613.50 ,"$2,707.00 ","$1,759.55 ",$613.50 ,$757.96 ,"$1,369.74 ",$613.50 ,"$1,556.53 ",$613.50 ,"$1,369.47 ",$613.50 ,"$1,165.65 ","$2,219.74 ","$1,533.75 ",$613.50 ,"$2,300.95 ","$2,436.30 ",$613.50 ,"$2,030.25 ","$1,894.90 ","$2,003.18 ","$2,003.18 ","$1,533.75 ","$2,300.95 ",$613.50 ,$613.50 ,"$1,897.61 ",$613.50 ,"$1,126.11 ", N/A ,"$2,300.95 ","$1,319.02 ",$757.96 ,"$2,436.30 ","$1,750.00 ",$613.50 ,"$1,759.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,$786.00 ,$510.90 ,$208.58 ,$786.00 ,$510.90 ,$208.58 ,$220.08 ,$397.72 ,$208.58 ,$451.95 ,$208.58 ,$397.64 ,$208.58 ,$396.30 ,$644.52 ,$521.44 ,$208.58 ,$668.10 ,$707.40 ,$208.58 ,$589.50 ,$550.20 ,$581.64 ,$581.64 ,$521.44 ,$668.10 ,$208.58 ,$208.58 ,$550.99 ,$208.58 ,$326.98 , N/A ,$668.10 ,$448.44 ,$220.08 ,$707.40 ,$250.00 ,$208.58 ,$510.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000061,N/A,HC ANESTHESIA GENERAL INITIAL 15MIN,370,1 ,$456.00 ,$296.40 ,$127.68 ,$456.00 ,$296.40 , N/A ,$127.68 ,$230.74 , N/A ,$262.20 , N/A ,$230.69 , N/A , N/A ,$373.92 , N/A , N/A ,$387.60 ,$410.40 , N/A ,$342.00 ,$319.20 ,$337.44 ,$337.44 , N/A ,$387.60 , N/A , N/A ,$319.66 , N/A ,$189.70 , N/A ,$387.60 , N/A ,$127.68 ,$410.40 ,$240.77 , N/A ,$296.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000062,N/A,HC ANESTHESIA GENERAL ADDL 15MIN,370,1 ,$286.00 ,$185.90 ,$80.08 ,$286.00 ,$185.90 , N/A ,$80.08 ,$144.72 , N/A ,$164.45 , N/A ,$144.69 , N/A , N/A ,$234.52 , N/A , N/A ,$243.10 ,$257.40 , N/A ,$214.50 ,$200.20 ,$211.64 ,$211.64 , N/A ,$243.10 , N/A , N/A ,$200.49 , N/A ,$118.98 , N/A ,$243.10 , N/A ,$80.08 ,$257.40 ,$151.01 , N/A ,$185.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000063,N/A,HC ANESTHESIA REGIONAL BLOCK INITIAL 15MIN,370,1 ,$478.00 ,$310.70 ,$133.84 ,$478.00 ,$310.70 , N/A ,$133.84 ,$241.87 , N/A ,$274.85 , N/A ,$241.82 , N/A , N/A ,$391.96 , N/A , N/A ,$406.30 ,$430.20 , N/A ,$358.50 ,$334.60 ,$353.72 ,$353.72 , N/A ,$406.30 , N/A , N/A ,$335.08 , N/A ,$198.85 , N/A ,$406.30 , N/A ,$133.84 ,$430.20 ,$252.38 , N/A ,$310.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000064,N/A,HC ANESTHESIA REGIONAL BLOCK ADDL 15MIN,370,1 ,$273.00 ,$177.45 ,$76.44 ,$273.00 ,$177.45 , N/A ,$76.44 ,$138.14 , N/A ,$156.98 , N/A ,$138.11 , N/A , N/A ,$223.86 , N/A , N/A ,$232.05 ,$245.70 , N/A ,$204.75 ,$191.10 ,$202.02 ,$202.02 , N/A ,$232.05 , N/A , N/A ,$191.37 , N/A ,$113.57 , N/A ,$232.05 , N/A ,$76.44 ,$245.70 ,$144.14 , N/A ,$177.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000076,N/A,HC MONITORED ANESTHESIA INITIAL 15 MINS,370,1 ,$455.00 ,$295.75 ,$127.40 ,$455.00 ,$295.75 , N/A ,$127.40 ,$230.23 , N/A ,$261.63 , N/A ,$230.18 , N/A , N/A ,$373.10 , N/A , N/A ,$386.75 ,$409.50 , N/A ,$341.25 ,$318.50 ,$336.70 ,$336.70 , N/A ,$386.75 , N/A , N/A ,$318.96 , N/A ,$189.28 , N/A ,$386.75 , N/A ,$127.40 ,$409.50 ,$240.24 , N/A ,$295.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37000077,N/A,HC MONITORED ANESTHESIA ADDL 15 MINS,370,1 ,$259.00 ,$168.35 ,$72.52 ,$259.00 ,$168.35 , N/A ,$72.52 ,$131.05 , N/A ,$148.93 , N/A ,$131.03 , N/A , N/A ,$212.38 , N/A , N/A ,$220.15 ,$233.10 , N/A ,$194.25 ,$181.30 ,$191.66 ,$191.66 , N/A ,$220.15 , N/A , N/A ,$181.56 , N/A ,$107.74 , N/A ,$220.15 , N/A ,$72.52 ,$233.10 ,$136.75 , N/A ,$168.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,"$1,807.00 ","$1,174.55 ",$505.96 ,"$1,807.00 ","$1,174.55 ",$626.03 ,$505.96 ,$914.34 ,$626.03 ,"$1,039.03 ",$626.03 ,$914.16 ,$626.03 ,"$1,189.46 ","$1,481.74 ","$1,565.07 ",$626.03 ,"$1,535.95 ","$1,626.30 ",$626.03 ,"$1,355.25 ","$1,264.90 ","$1,337.18 ","$1,337.18 ","$1,565.07 ","$1,535.95 ",$626.03 ,$626.03 ,"$1,266.71 ",$626.03 ,$751.71 , N/A ,"$1,535.95 ","$1,345.96 ",$505.96 ,"$1,626.30 ","$1,750.00 ",$626.03 ,"$1,174.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000148,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$186.00 ,$120.90 ,$52.08 ,$211.00 ,$120.90 ,$84.40 ,$52.08 ,$94.12 ,$84.40 ,$106.95 ,$84.40 ,$94.10 ,$84.40 ,$160.36 ,$152.52 ,$211.00 ,$84.40 ,$158.10 ,$167.40 ,$84.40 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$84.40 ,$84.40 ,$130.39 ,$84.40 ,$77.38 , N/A ,$158.10 ,$181.46 ,$52.08 ,$167.40 ,$186.00 ,$84.40 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000151,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,"$1,141.00 ",$741.65 ,$153.07 ,"$1,141.00 ",$741.65 ,$153.07 ,$319.48 ,$577.35 ,$153.07 ,$656.08 ,$153.07 ,$577.23 ,$153.07 ,$290.83 ,$935.62 ,$382.68 ,$153.07 ,$969.85 ,"$1,026.90 ",$153.07 ,$855.75 ,$798.70 ,$844.34 ,$844.34 ,$382.68 ,$969.85 ,$153.07 ,$153.07 ,$799.84 ,$153.07 ,$474.66 , N/A ,$969.85 ,$329.10 ,$319.48 ,"$1,026.90 ",$300.00 ,$153.07 ,$741.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000152,P9033,HC PLATELETS L/R IRR EA,390,1 ,"$1,041.00 ",$676.65 ,$217.66 ,"$1,041.00 ",$676.65 ,$217.66 ,$291.48 ,$526.75 ,$217.66 ,$598.58 ,$217.66 ,$526.64 ,$217.66 ,$413.55 ,$853.62 ,$544.15 ,$217.66 ,$884.85 ,$936.90 ,$217.66 ,$780.75 ,$728.70 ,$770.34 ,$770.34 ,$544.15 ,$884.85 ,$217.66 ,$217.66 ,$729.74 ,$217.66 ,$433.06 , N/A ,$884.85 ,$467.97 ,$291.48 ,$936.90 ,$300.00 ,$217.66 ,$676.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000160,P9059,HC PLASMA FROZEN 8-24 HRS EA UNIT,390,1 ,$189.00 ,$122.85 ,$52.92 ,$189.00 ,$122.85 ,$72.64 ,$52.92 ,$95.63 ,$72.64 ,$108.68 ,$72.64 ,$95.62 ,$72.64 ,$138.02 ,$154.98 ,$181.60 ,$72.64 ,$160.65 ,$170.10 ,$72.64 ,$141.75 ,$132.30 ,$139.86 ,$139.86 ,$181.60 ,$160.65 ,$72.64 ,$72.64 ,$132.49 ,$72.64 ,$78.62 , N/A ,$160.65 ,$156.18 ,$52.92 ,$170.10 ,$189.00 ,$72.64 ,$122.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000164,P9016,HC RED CELLS L/R EA T1,390,1 ,$650.00 ,$422.50 ,$182.00 ,$650.00 ,$422.50 ,$192.39 ,$182.00 ,$328.90 ,$192.39 ,$373.75 ,$192.39 ,$328.84 ,$192.39 ,$365.54 ,$533.00 ,$480.98 ,$192.39 ,$552.50 ,$585.00 ,$192.39 ,$487.50 ,$455.00 ,$481.00 ,$481.00 ,$480.98 ,$552.50 ,$192.39 ,$192.39 ,$455.65 ,$192.39 ,$270.40 , N/A ,$552.50 ,$413.64 ,$182.00 ,$585.00 ,$300.00 ,$192.39 ,$422.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000173,P9035,HC PLATELETS PHER L/R EA T1,390,1 ,"$1,256.00 ",$816.40 ,$300.00 ,"$1,256.00 ",$816.40 ,$496.91 ,$351.68 ,$635.54 ,$496.91 ,$722.20 ,$496.91 ,$635.41 ,$496.91 ,$944.13 ,"$1,029.92 ","$1,242.28 ",$496.91 ,"$1,067.60 ","$1,130.40 ",$496.91 ,$942.00 ,$879.20 ,$929.44 ,$929.44 ,"$1,242.28 ","$1,067.60 ",$496.91 ,$496.91 ,$880.46 ,$496.91 ,$522.50 , N/A ,"$1,067.60 ","$1,068.36 ",$351.68 ,"$1,130.40 ",$300.00 ,$496.91 ,$816.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000179,P9037,HC PLATELETS PHER L/R IRR EA T1,390,1 ,"$1,145.00 ",$744.25 ,$300.00 ,"$1,575.80 ",$744.25 ,$630.32 ,$320.60 ,$579.37 ,$630.32 ,$658.38 ,$630.32 ,$579.26 ,$630.32 ,"$1,145.00 ",$938.90 ,"$1,575.80 ",$630.32 ,$973.25 ,"$1,030.50 ",$630.32 ,$858.75 ,$801.50 ,$847.30 ,$847.30 ,"$1,145.00 ",$973.25 ,$630.32 ,$630.32 ,$802.65 ,$630.32 ,$476.32 , N/A ,$973.25 ,"$1,355.19 ",$320.60 ,"$1,030.50 ",$300.00 ,$630.32 ,$744.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000187,P9040,HC RED CELLS L/R IRR EA T1,390,1 ,$708.00 ,$460.20 ,$198.24 ,$708.00 ,$460.20 ,$266.03 ,$198.24 ,$358.25 ,$266.03 ,$407.10 ,$266.03 ,$358.18 ,$266.03 ,$505.46 ,$580.56 ,$665.08 ,$266.03 ,$601.80 ,$637.20 ,$266.03 ,$531.00 ,$495.60 ,$523.92 ,$523.92 ,$665.08 ,$601.80 ,$266.03 ,$266.03 ,$496.31 ,$266.03 ,$294.53 , N/A ,$601.80 ,$571.96 ,$198.24 ,$637.20 ,$300.00 ,$266.03 ,$460.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39000205,P9073,HC PLATELETS PHERESIS PATH REDUCED EA UN T1,390,1 ,"$1,138.00 ",$739.70 ,$300.00 ,"$1,490.33 ",$739.70 ,$596.13 ,$318.64 ,$575.83 ,$596.13 ,$654.35 ,$596.13 ,$575.71 ,$596.13 ,"$1,132.65 ",$933.16 ,"$1,490.33 ",$596.13 ,$967.30 ,"$1,024.20 ",$596.13 ,$853.50 ,$796.60 ,$842.12 ,$842.12 ,"$1,138.00 ",$967.30 ,$596.13 ,$596.13 ,$797.74 ,$596.13 ,$473.41 , N/A ,$967.30 ,"$1,281.68 ",$318.64 ,"$1,024.20 ",$300.00 ,$596.13 ,$739.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$574.00 ,$373.10 ,$160.72 ,$978.28 ,$373.10 ,$391.31 ,$160.72 ,$290.44 ,$391.31 ,$330.05 ,$391.31 ,$290.39 ,$391.31 ,$574.00 ,$470.68 ,$978.28 ,$391.31 ,$487.90 ,$516.60 ,$391.31 ,$430.50 ,$401.80 ,$424.76 ,$424.76 ,$574.00 ,$487.90 ,$391.31 ,$391.31 ,$402.37 ,$391.31 ,$238.78 , N/A ,$487.90 ,$841.32 ,$160.72 ,$516.60 ,$300.00 ,$391.31 ,$373.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$696.00 ,$452.40 ,$109.13 ,$696.00 ,$452.40 ,$109.13 ,$194.88 ,$352.18 ,$109.13 ,$400.20 ,$109.13 ,$352.11 ,$109.13 ,$207.35 ,$570.72 ,$272.83 ,$109.13 ,$591.60 ,$626.40 ,$109.13 ,$522.00 ,$487.20 ,$515.04 ,$515.04 ,$272.83 ,$591.60 ,$109.13 ,$109.13 ,$487.90 ,$109.13 ,$289.54 , N/A ,$591.60 ,$234.63 ,$194.88 ,$626.40 ,$210.00 ,$109.13 ,$452.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$696.00 ,$452.40 ,$109.13 ,$696.00 ,$452.40 ,$109.13 ,$194.88 ,$352.18 ,$109.13 ,$400.20 ,$109.13 ,$352.11 ,$109.13 ,$207.35 ,$570.72 ,$272.83 ,$109.13 ,$591.60 ,$626.40 ,$109.13 ,$522.00 ,$487.20 ,$515.04 ,$515.04 ,$272.83 ,$591.60 ,$109.13 ,$109.13 ,$487.90 ,$109.13 ,$289.54 , N/A ,$591.60 ,$234.63 ,$194.88 ,$626.40 ,$210.00 ,$109.13 ,$452.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$696.00 ,$452.40 ,$109.13 ,$696.00 ,$452.40 ,$109.13 ,$194.88 ,$352.18 ,$109.13 ,$400.20 ,$109.13 ,$352.11 ,$109.13 ,$207.35 ,$570.72 ,$272.83 ,$109.13 ,$591.60 ,$626.40 ,$109.13 ,$522.00 ,$487.20 ,$515.04 ,$515.04 ,$272.83 ,$591.60 ,$109.13 ,$109.13 ,$487.90 ,$109.13 ,$289.54 , N/A ,$591.60 ,$234.63 ,$194.88 ,$626.40 ,$210.00 ,$109.13 ,$452.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$521.00 ,$338.65 ,$85.66 ,$521.00 ,$338.65 ,$85.66 ,$145.88 ,$263.63 ,$85.66 ,$299.58 ,$85.66 ,$263.57 ,$85.66 ,$162.75 ,$427.22 ,$214.15 ,$85.66 ,$442.85 ,$468.90 ,$85.66 ,$390.75 ,$364.70 ,$385.54 ,$385.54 ,$214.15 ,$442.85 ,$85.66 ,$85.66 ,$365.22 ,$85.66 ,$216.74 , N/A ,$442.85 ,$184.17 ,$145.88 ,$468.90 ,$210.00 ,$85.66 ,$338.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$521.00 ,$338.65 ,$85.66 ,$521.00 ,$338.65 ,$85.66 ,$145.88 ,$263.63 ,$85.66 ,$299.58 ,$85.66 ,$263.57 ,$85.66 ,$162.75 ,$427.22 ,$214.15 ,$85.66 ,$442.85 ,$468.90 ,$85.66 ,$390.75 ,$364.70 ,$385.54 ,$385.54 ,$214.15 ,$442.85 ,$85.66 ,$85.66 ,$365.22 ,$85.66 ,$216.74 , N/A ,$442.85 ,$184.17 ,$145.88 ,$468.90 ,$210.00 ,$85.66 ,$338.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$521.00 ,$338.65 ,$85.66 ,$521.00 ,$338.65 ,$85.66 ,$145.88 ,$263.63 ,$85.66 ,$299.58 ,$85.66 ,$263.57 ,$85.66 ,$162.75 ,$427.22 ,$214.15 ,$85.66 ,$442.85 ,$468.90 ,$85.66 ,$390.75 ,$364.70 ,$385.54 ,$385.54 ,$214.15 ,$442.85 ,$85.66 ,$85.66 ,$365.22 ,$85.66 ,$216.74 , N/A ,$442.85 ,$184.17 ,$145.88 ,$468.90 ,$210.00 ,$85.66 ,$338.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$132.00 ,$85.80 ,$22.82 ,$132.00 ,$85.80 ,$22.82 ,$36.96 ,$66.79 ,$22.82 ,$75.90 ,$22.82 ,$66.78 ,$22.82 ,$43.36 ,$108.24 ,$57.05 ,$22.82 ,$112.20 ,$118.80 ,$22.82 ,$99.00 ,$92.40 ,$97.68 ,$97.68 ,$57.05 ,$112.20 ,$22.82 ,$22.82 ,$92.53 ,$22.82 ,$54.91 , N/A ,$112.20 ,$49.06 ,$36.96 ,$118.80 ,$132.00 ,$22.82 ,$85.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200007,51798,HC US BLADDER SCAN,402,1 ,$453.00 ,$294.45 ,$54.88 ,$453.00 ,$294.45 ,$54.88 ,$126.84 ,$229.22 ,$54.88 ,$260.48 ,$54.88 ,$229.17 ,$54.88 ,$104.27 ,$371.46 ,$137.20 ,$54.88 ,$385.05 ,$407.70 ,$54.88 ,$339.75 ,$317.10 ,$335.22 ,$335.22 ,$137.20 ,$385.05 ,$54.88 ,$54.88 ,$317.55 ,$54.88 ,$188.45 , N/A ,$385.05 ,$117.99 ,$126.84 ,$407.70 ,$400.00 ,$54.88 ,$294.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,"$1,085.00 ",$705.25 ,$107.33 ,"$1,085.00 ",$705.25 ,$107.33 ,$303.80 ,$549.01 ,$107.33 ,$623.88 ,$107.33 ,$548.90 ,$107.33 ,$203.93 ,$889.70 ,$268.33 ,$107.33 ,$922.25 ,$976.50 ,$107.33 ,$813.75 ,$759.50 ,$802.90 ,$802.90 ,$268.33 ,$922.25 ,$107.33 ,$107.33 ,$760.59 ,$107.33 ,$451.36 , N/A ,$922.25 ,$230.77 ,$303.80 ,$976.50 ,$400.00 ,$107.33 ,$705.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200014,76604,HC US CHEST,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,$894.00 ,$581.10 ,$107.33 ,$894.00 ,$581.10 ,$107.33 ,$250.32 ,$452.36 ,$107.33 ,$514.05 ,$107.33 ,$452.27 ,$107.33 ,$203.93 ,$733.08 ,$268.33 ,$107.33 ,$759.90 ,$804.60 ,$107.33 ,$670.50 ,$625.80 ,$661.56 ,$661.56 ,$268.33 ,$759.90 ,$107.33 ,$107.33 ,$626.69 ,$107.33 ,$371.90 , N/A ,$759.90 ,$230.77 ,$250.32 ,$804.60 ,$400.00 ,$107.33 ,$581.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,288.00 ",$837.20 ,$107.33 ,"$1,288.00 ",$837.20 ,$107.33 ,$360.64 ,$651.73 ,$107.33 ,$740.60 ,$107.33 ,$651.60 ,$107.33 ,$203.93 ,"$1,056.16 ",$268.33 ,$107.33 ,"$1,094.80 ","$1,159.20 ",$107.33 ,$966.00 ,$901.60 ,$953.12 ,$953.12 ,$268.33 ,"$1,094.80 ",$107.33 ,$107.33 ,$902.89 ,$107.33 ,$535.81 , N/A ,"$1,094.80 ",$230.77 ,$360.64 ,"$1,159.20 ",$400.00 ,$107.33 ,$837.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200018,76705,HC US ABDOMEN LTD,402,1 ,"$1,169.00 ",$759.85 ,$107.33 ,"$1,169.00 ",$759.85 ,$107.33 ,$327.32 ,$591.51 ,$107.33 ,$672.18 ,$107.33 ,$591.40 ,$107.33 ,$203.93 ,$958.58 ,$268.33 ,$107.33 ,$993.65 ,"$1,052.10 ",$107.33 ,$876.75 ,$818.30 ,$865.06 ,$865.06 ,$268.33 ,$993.65 ,$107.33 ,$107.33 ,$819.47 ,$107.33 ,$486.30 , N/A ,$993.65 ,$230.77 ,$327.32 ,"$1,052.10 ",$400.00 ,$107.33 ,$759.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200019,76770,HC US RETROPERITIONEAL,402,1 ,"$1,169.00 ",$759.85 ,$107.33 ,"$1,169.00 ",$759.85 ,$107.33 ,$327.32 ,$591.51 ,$107.33 ,$672.18 ,$107.33 ,$591.40 ,$107.33 ,$203.93 ,$958.58 ,$268.33 ,$107.33 ,$993.65 ,"$1,052.10 ",$107.33 ,$876.75 ,$818.30 ,$865.06 ,$865.06 ,$268.33 ,$993.65 ,$107.33 ,$107.33 ,$819.47 ,$107.33 ,$486.30 , N/A ,$993.65 ,$230.77 ,$327.32 ,"$1,052.10 ",$400.00 ,$107.33 ,$759.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200021,76776,HC US KIDNEY TRANSPLANT W/DOPPLER,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,"$1,080.00 ",$702.00 ,$107.33 ,"$1,080.00 ",$702.00 ,$107.33 ,$302.40 ,$546.48 ,$107.33 ,$621.00 ,$107.33 ,$546.37 ,$107.33 ,$203.93 ,$885.60 ,$268.33 ,$107.33 ,$918.00 ,$972.00 ,$107.33 ,$810.00 ,$756.00 ,$799.20 ,$799.20 ,$268.33 ,$918.00 ,$107.33 ,$107.33 ,$757.08 ,$107.33 ,$449.28 , N/A ,$918.00 ,$230.77 ,$302.40 ,$972.00 ,$400.00 ,$107.33 ,$702.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$915.00 ,$594.75 ,$256.20 ,$915.00 ,$594.75 , N/A ,$256.20 ,$462.99 , N/A ,$526.13 , N/A ,$462.90 , N/A , N/A ,$750.30 , N/A , N/A ,$777.75 ,$823.50 , N/A ,$686.25 ,$640.50 ,$677.10 ,$677.10 , N/A ,$777.75 , N/A , N/A ,$641.42 , N/A ,$380.64 , N/A ,$777.75 , N/A ,$256.20 ,$823.50 ,$400.00 , N/A ,$594.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,"$1,080.00 ",$702.00 ,$107.33 ,"$1,080.00 ",$702.00 ,$107.33 ,$302.40 ,$546.48 ,$107.33 ,$621.00 ,$107.33 ,$546.37 ,$107.33 ,$203.93 ,$885.60 ,$268.33 ,$107.33 ,$918.00 ,$972.00 ,$107.33 ,$810.00 ,$756.00 ,$799.20 ,$799.20 ,$268.33 ,$918.00 ,$107.33 ,$107.33 ,$757.08 ,$107.33 ,$449.28 , N/A ,$918.00 ,$230.77 ,$302.40 ,$972.00 ,$400.00 ,$107.33 ,$702.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,$403.00 ,$261.95 ,$112.84 ,$403.00 ,$261.95 , N/A ,$112.84 ,$203.92 , N/A ,$231.73 , N/A ,$203.88 , N/A , N/A ,$330.46 , N/A , N/A ,$342.55 ,$362.70 , N/A ,$302.25 ,$282.10 ,$298.22 ,$298.22 , N/A ,$342.55 , N/A , N/A ,$282.50 , N/A ,$167.65 , N/A ,$342.55 , N/A ,$112.84 ,$362.70 ,$400.00 , N/A ,$261.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,$655.00 ,$425.75 ,$183.40 ,$655.00 ,$425.75 ,$226.85 ,$183.40 ,$331.43 ,$226.85 ,$376.63 ,$226.85 ,$331.36 ,$226.85 ,$431.02 ,$537.10 ,$567.13 ,$226.85 ,$556.75 ,$589.50 ,$226.85 ,$491.25 ,$458.50 ,$484.70 ,$484.70 ,$567.13 ,$556.75 ,$226.85 ,$226.85 ,$459.16 ,$226.85 ,$272.48 , N/A ,$556.75 ,$487.73 ,$183.40 ,$589.50 ,$400.00 ,$226.85 ,$425.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$911.00 ,$592.15 ,$107.33 ,$911.00 ,$592.15 ,$107.33 ,$255.08 ,$460.97 ,$107.33 ,$523.83 ,$107.33 ,$460.87 ,$107.33 ,$203.93 ,$747.02 ,$268.33 ,$107.33 ,$774.35 ,$819.90 ,$107.33 ,$683.25 ,$637.70 ,$674.14 ,$674.14 ,$268.33 ,$774.35 ,$107.33 ,$107.33 ,$638.61 ,$107.33 ,$378.98 , N/A ,$774.35 ,$230.77 ,$255.08 ,$819.90 ,$400.00 ,$107.33 ,$592.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200031,76815,HC US FETAL HEART BEAT,402,1 ,$773.00 ,$502.45 ,$107.33 ,$773.00 ,$502.45 ,$107.33 ,$216.44 ,$391.14 ,$107.33 ,$444.48 ,$107.33 ,$391.06 ,$107.33 ,$203.93 ,$633.86 ,$268.33 ,$107.33 ,$657.05 ,$695.70 ,$107.33 ,$579.75 ,$541.10 ,$572.02 ,$572.02 ,$268.33 ,$657.05 ,$107.33 ,$107.33 ,$541.87 ,$107.33 ,$321.57 , N/A ,$657.05 ,$230.77 ,$216.44 ,$695.70 ,$400.00 ,$107.33 ,$502.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$880.00 ,$572.00 ,$107.33 ,$880.00 ,$572.00 ,$107.33 ,$246.40 ,$445.28 ,$107.33 ,$506.00 ,$107.33 ,$445.19 ,$107.33 ,$203.93 ,$721.60 ,$268.33 ,$107.33 ,$748.00 ,$792.00 ,$107.33 ,$660.00 ,$616.00 ,$651.20 ,$651.20 ,$268.33 ,$748.00 ,$107.33 ,$107.33 ,$616.88 ,$107.33 ,$366.08 , N/A ,$748.00 ,$230.77 ,$246.40 ,$792.00 ,$400.00 ,$107.33 ,$572.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200033,76818,HC US FETAL BIO PROFILE W/NST,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,$915.00 ,$594.75 ,$107.33 ,$915.00 ,$594.75 ,$107.33 ,$256.20 ,$462.99 ,$107.33 ,$526.13 ,$107.33 ,$462.90 ,$107.33 ,$203.93 ,$750.30 ,$268.33 ,$107.33 ,$777.75 ,$823.50 ,$107.33 ,$686.25 ,$640.50 ,$677.10 ,$677.10 ,$268.33 ,$777.75 ,$107.33 ,$107.33 ,$641.42 ,$107.33 ,$380.64 , N/A ,$777.75 ,$230.77 ,$256.20 ,$823.50 ,$400.00 ,$107.33 ,$594.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200035,76819,HC US FETAL BIO PROFILE W/O NST EA ADDN,402,1 ,$915.00 ,$594.75 ,$107.33 ,$915.00 ,$594.75 ,$107.33 ,$256.20 ,$462.99 ,$107.33 ,$526.13 ,$107.33 ,$462.90 ,$107.33 ,$203.93 ,$750.30 ,$268.33 ,$107.33 ,$777.75 ,$823.50 ,$107.33 ,$686.25 ,$640.50 ,$677.10 ,$677.10 ,$268.33 ,$777.75 ,$107.33 ,$107.33 ,$641.42 ,$107.33 ,$380.64 , N/A ,$777.75 ,$230.77 ,$256.20 ,$823.50 ,$400.00 ,$107.33 ,$594.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200038,76830,HC US TRANSVAGINAL,402,1 ,$915.00 ,$594.75 ,$107.33 ,$915.00 ,$594.75 ,$107.33 ,$256.20 ,$462.99 ,$107.33 ,$526.13 ,$107.33 ,$462.90 ,$107.33 ,$203.93 ,$750.30 ,$268.33 ,$107.33 ,$777.75 ,$823.50 ,$107.33 ,$686.25 ,$640.50 ,$677.10 ,$677.10 ,$268.33 ,$777.75 ,$107.33 ,$107.33 ,$641.42 ,$107.33 ,$380.64 , N/A ,$777.75 ,$230.77 ,$256.20 ,$823.50 ,$400.00 ,$107.33 ,$594.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200040,76856,HC US PELVIS NON OB,402,1 ,"$1,288.00 ",$837.20 ,$107.33 ,"$1,288.00 ",$837.20 ,$107.33 ,$360.64 ,$651.73 ,$107.33 ,$740.60 ,$107.33 ,$651.60 ,$107.33 ,$203.93 ,"$1,056.16 ",$268.33 ,$107.33 ,"$1,094.80 ","$1,159.20 ",$107.33 ,$966.00 ,$901.60 ,$953.12 ,$953.12 ,$268.33 ,"$1,094.80 ",$107.33 ,$107.33 ,$902.89 ,$107.33 ,$535.81 , N/A ,"$1,094.80 ",$230.77 ,$360.64 ,"$1,159.20 ",$400.00 ,$107.33 ,$837.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,"$1,169.00 ",$759.85 ,$107.33 ,"$1,169.00 ",$759.85 ,$107.33 ,$327.32 ,$591.51 ,$107.33 ,$672.18 ,$107.33 ,$591.40 ,$107.33 ,$203.93 ,$958.58 ,$268.33 ,$107.33 ,$993.65 ,"$1,052.10 ",$107.33 ,$876.75 ,$818.30 ,$865.06 ,$865.06 ,$268.33 ,$993.65 ,$107.33 ,$107.33 ,$819.47 ,$107.33 ,$486.30 , N/A ,$993.65 ,$230.77 ,$327.32 ,"$1,052.10 ",$400.00 ,$107.33 ,$759.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200042,76870,HC US SCROTUM,402,1 ,"$1,004.00 ",$652.60 ,$107.33 ,"$1,004.00 ",$652.60 ,$107.33 ,$281.12 ,$508.02 ,$107.33 ,$577.30 ,$107.33 ,$507.92 ,$107.33 ,$203.93 ,$823.28 ,$268.33 ,$107.33 ,$853.40 ,$903.60 ,$107.33 ,$753.00 ,$702.80 ,$742.96 ,$742.96 ,$268.33 ,$853.40 ,$107.33 ,$107.33 ,$703.80 ,$107.33 ,$417.66 , N/A ,$853.40 ,$230.77 ,$281.12 ,$903.60 ,$400.00 ,$107.33 ,$652.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$915.00 ,$594.75 ,$107.33 ,$915.00 ,$594.75 ,$107.33 ,$256.20 ,$462.99 ,$107.33 ,$526.13 ,$107.33 ,$462.90 ,$107.33 ,$203.93 ,$750.30 ,$268.33 ,$107.33 ,$777.75 ,$823.50 ,$107.33 ,$686.25 ,$640.50 ,$677.10 ,$677.10 ,$268.33 ,$777.75 ,$107.33 ,$107.33 ,$641.42 ,$107.33 ,$380.64 , N/A ,$777.75 ,$230.77 ,$256.20 ,$823.50 ,$400.00 ,$107.33 ,$594.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200050,76936,HC US GUIDED COMPRESSION RPR,402,1 ,$753.00 ,$489.45 ,$210.84 ,$753.00 ,$489.45 ,$260.92 ,$210.84 ,$381.02 ,$260.92 ,$432.98 ,$260.92 ,$380.94 ,$260.92 ,$495.74 ,$617.46 ,$652.29 ,$260.92 ,$640.05 ,$677.70 ,$260.92 ,$564.75 ,$527.10 ,$557.22 ,$557.22 ,$652.29 ,$640.05 ,$260.92 ,$260.92 ,$527.85 ,$260.92 ,$313.25 , N/A ,$640.05 ,$560.97 ,$210.84 ,$677.70 ,$400.00 ,$260.92 ,$489.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,"$1,394.00 ",$906.10 ,$390.32 ,"$1,394.00 ",$906.10 , N/A ,$390.32 ,$705.36 , N/A ,$801.55 , N/A ,$705.22 , N/A , N/A ,"$1,143.08 ", N/A , N/A ,"$1,184.90 ","$1,254.60 ", N/A ,"$1,045.50 ",$975.80 ,"$1,031.56 ","$1,031.56 ", N/A ,"$1,184.90 ", N/A , N/A ,$977.19 , N/A ,$579.90 , N/A ,"$1,184.90 ", N/A ,$390.32 ,"$1,254.60 ",$400.00 , N/A ,$906.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,003.00 ",$651.95 ,$280.84 ,"$1,003.00 ",$651.95 , N/A ,$280.84 ,$507.52 , N/A ,$576.73 , N/A ,$507.42 , N/A , N/A ,$822.46 , N/A , N/A ,$852.55 ,$902.70 , N/A ,$752.25 ,$702.10 ,$742.22 ,$742.22 , N/A ,$852.55 , N/A , N/A ,$703.10 , N/A ,$417.25 , N/A ,$852.55 , N/A ,$280.84 ,$902.70 ,$400.00 , N/A ,$651.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200062,76998,HC US INTRAOPERATIVE,402,1 ,"$1,077.00 ",$700.05 ,$301.56 ,"$1,077.00 ",$700.05 , N/A ,$301.56 ,$544.96 , N/A ,$619.28 , N/A ,$544.85 , N/A , N/A ,$883.14 , N/A , N/A ,$915.45 ,$969.30 , N/A ,$807.75 ,$753.90 ,$796.98 ,$796.98 , N/A ,$915.45 , N/A , N/A ,$754.98 , N/A ,$448.03 , N/A ,$915.45 , N/A ,$301.56 ,$969.30 ,$400.00 , N/A ,$700.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,$655.00 ,$425.75 ,$183.40 ,$655.00 ,$425.75 ,$226.85 ,$183.40 ,$331.43 ,$226.85 ,$376.63 ,$226.85 ,$331.36 ,$226.85 ,$431.02 ,$537.10 ,$567.13 ,$226.85 ,$556.75 ,$589.50 ,$226.85 ,$491.25 ,$458.50 ,$484.70 ,$484.70 ,$567.13 ,$556.75 ,$226.85 ,$226.85 ,$459.16 ,$226.85 ,$272.48 , N/A ,$556.75 ,$487.73 ,$183.40 ,$589.50 ,$400.00 ,$226.85 ,$425.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,"$1,456.00 ",$946.40 ,$107.33 ,"$1,456.00 ",$946.40 ,$107.33 ,$407.68 ,$736.74 ,$107.33 ,$837.20 ,$107.33 ,$736.59 ,$107.33 ,$203.93 ,"$1,193.92 ",$268.33 ,$107.33 ,"$1,237.60 ","$1,310.40 ",$107.33 ,"$1,092.00 ","$1,019.20 ","$1,077.44 ","$1,077.44 ",$268.33 ,"$1,237.60 ",$107.33 ,$107.33 ,"$1,020.66 ",$107.33 ,$605.70 , N/A ,"$1,237.60 ",$230.77 ,$407.68 ,"$1,310.40 ",$400.00 ,$107.33 ,$946.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,456.00 ",$946.40 ,$107.33 ,"$1,456.00 ",$946.40 ,$107.33 ,$407.68 ,$736.74 ,$107.33 ,$837.20 ,$107.33 ,$736.59 ,$107.33 ,$203.93 ,"$1,193.92 ",$268.33 ,$107.33 ,"$1,237.60 ","$1,310.40 ",$107.33 ,"$1,092.00 ","$1,019.20 ","$1,077.44 ","$1,077.44 ",$268.33 ,"$1,237.60 ",$107.33 ,$107.33 ,"$1,020.66 ",$107.33 ,$605.70 , N/A ,"$1,237.60 ",$230.77 ,$407.68 ,"$1,310.40 ",$400.00 ,$107.33 ,$946.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,"$1,456.00 ",$946.40 ,$226.85 ,"$1,456.00 ",$946.40 ,$226.85 ,$407.68 ,$736.74 ,$226.85 ,$837.20 ,$226.85 ,$736.59 ,$226.85 ,$431.02 ,"$1,193.92 ",$567.13 ,$226.85 ,"$1,237.60 ","$1,310.40 ",$226.85 ,"$1,092.00 ","$1,019.20 ","$1,077.44 ","$1,077.44 ",$567.13 ,"$1,237.60 ",$226.85 ,$226.85 ,"$1,020.66 ",$226.85 ,$605.70 , N/A ,"$1,237.60 ",$487.73 ,$407.68 ,"$1,310.40 ",$768.77 ,$226.85 ,$946.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200075,76706,HC US AORTA (SCREENING),402,1 ,$915.00 ,$594.75 ,$107.33 ,$915.00 ,$594.75 ,$107.33 ,$256.20 ,$462.99 ,$107.33 ,$526.13 ,$107.33 ,$462.90 ,$107.33 ,$203.93 ,$750.30 ,$268.33 ,$107.33 ,$777.75 ,$823.50 ,$107.33 ,$686.25 ,$640.50 ,$677.10 ,$677.10 ,$268.33 ,$777.75 ,$107.33 ,$107.33 ,$641.42 ,$107.33 ,$380.64 , N/A ,$777.75 ,$230.77 ,$256.20 ,$823.50 ,$400.00 ,$107.33 ,$594.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200091,76886,HC US HIPS INFANT STATIC,402,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 ,$149.50 ,$79.75 ,$64.40 ,$116.38 ,$79.75 ,$132.25 ,$79.75 ,$116.36 ,$79.75 ,$151.52 ,$188.60 ,$199.36 ,$79.75 ,$195.50 ,$207.00 ,$79.75 ,$172.50 ,$161.00 ,$170.20 ,$170.20 ,$199.36 ,$195.50 ,$79.75 ,$79.75 ,$161.23 ,$79.75 ,$95.68 , N/A ,$195.50 ,$171.45 ,$64.40 ,$207.00 ,$230.00 ,$79.75 ,$149.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200092,76813,HC US FETAL NUCHAL TRANSLUCENCY SNG,402,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$310.00 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40200097,76816,HC US OB GROWTH FOLLOWUP EA ADDN,402,1 ,$911.00 ,$592.15 ,$107.33 ,$911.00 ,$592.15 ,$107.33 ,$255.08 ,$460.97 ,$107.33 ,$523.83 ,$107.33 ,$460.87 ,$107.33 ,$203.93 ,$747.02 ,$268.33 ,$107.33 ,$774.35 ,$819.90 ,$107.33 ,$683.25 ,$637.70 ,$674.14 ,$674.14 ,$268.33 ,$774.35 ,$107.33 ,$107.33 ,$638.61 ,$107.33 ,$378.98 , N/A ,$774.35 ,$230.77 ,$255.08 ,$819.90 ,$400.00 ,$107.33 ,$592.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$432.00 ,$280.80 ,$90.22 ,$432.00 ,$280.80 ,$90.22 ,$120.96 ,$218.59 ,$90.22 ,$248.40 ,$90.22 ,$218.55 ,$90.22 ,$171.42 ,$354.24 ,$225.55 ,$90.22 ,$367.20 ,$388.80 ,$90.22 ,$324.00 ,$302.40 ,$319.68 ,$319.68 ,$225.55 ,$367.20 ,$90.22 ,$90.22 ,$302.83 ,$90.22 ,$179.71 , N/A ,$367.20 ,$193.97 ,$120.96 ,$388.80 ,$210.00 ,$90.22 ,$280.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$432.00 ,$280.80 ,$90.22 ,$432.00 ,$280.80 ,$90.22 ,$120.96 ,$218.59 ,$90.22 ,$248.40 ,$90.22 ,$218.55 ,$90.22 ,$171.42 ,$354.24 ,$225.55 ,$90.22 ,$367.20 ,$388.80 ,$90.22 ,$324.00 ,$302.40 ,$319.68 ,$319.68 ,$225.55 ,$367.20 ,$90.22 ,$90.22 ,$302.83 ,$90.22 ,$179.71 , N/A ,$367.20 ,$193.97 ,$120.96 ,$388.80 ,$210.00 ,$90.22 ,$280.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$121.00 ,$78.65 ,$22.82 ,$121.00 ,$78.65 ,$22.82 ,$33.88 ,$61.23 ,$22.82 ,$69.58 ,$22.82 ,$61.21 ,$22.82 ,$43.36 ,$99.22 ,$57.05 ,$22.82 ,$102.85 ,$108.90 ,$22.82 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$57.05 ,$102.85 ,$22.82 ,$22.82 ,$84.82 ,$22.82 ,$50.34 , N/A ,$102.85 ,$49.06 ,$33.88 ,$108.90 ,$121.00 ,$22.82 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000005,92950,HC CPR,480,1 ,$709.00 ,$460.85 ,$198.52 ,$709.00 ,$460.85 ,$260.92 ,$198.52 ,$358.75 ,$260.92 ,$407.68 ,$260.92 ,$358.68 ,$260.92 ,$495.74 ,$581.38 ,$652.29 ,$260.92 ,$602.65 ,$638.10 ,$260.92 ,$531.75 ,$496.30 ,$524.66 ,$524.66 ,$652.29 ,$602.65 ,$260.92 ,$260.92 ,$497.01 ,$260.92 ,$294.94 , N/A ,$602.65 ,$560.97 ,$198.52 ,$638.10 ,$709.00 ,$260.92 ,$460.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,$996.00 ,$647.40 ,$175.00 ,"$1,200.71 ",$647.40 ,$480.29 ,$278.88 ,$503.98 ,$480.29 ,$572.70 ,$480.29 ,$503.88 ,$480.29 ,$912.54 ,$816.72 ,"$1,200.71 ",$480.29 ,$846.60 ,$896.40 ,$480.29 ,$747.00 ,$697.20 ,$737.04 ,$737.04 ,$996.00 ,$846.60 ,$480.29 ,$480.29 ,$698.20 ,$480.29 ,$414.34 , N/A ,$846.60 ,"$1,032.61 ",$278.88 ,$896.40 ,$175.00 ,$480.29 ,$647.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000010,94002,HC VENTIL HI FREQ INTL DAY,410,1 ,$996.00 ,$647.40 ,$175.00 ,"$1,200.71 ",$647.40 ,$480.29 ,$278.88 ,$503.98 ,$480.29 ,$572.70 ,$480.29 ,$503.88 ,$480.29 ,$912.54 ,$816.72 ,"$1,200.71 ",$480.29 ,$846.60 ,$896.40 ,$480.29 ,$747.00 ,$697.20 ,$737.04 ,$737.04 ,$996.00 ,$846.60 ,$480.29 ,$480.29 ,$698.20 ,$480.29 ,$414.34 , N/A ,$846.60 ,"$1,032.61 ",$278.88 ,$896.40 ,$175.00 ,$480.29 ,$647.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$597.00 ,$388.05 ,$167.16 ,$597.00 ,$388.05 ,$185.31 ,$167.16 ,$302.08 ,$185.31 ,$343.28 ,$185.31 ,$302.02 ,$185.31 ,$352.09 ,$489.54 ,$463.28 ,$185.31 ,$507.45 ,$537.30 ,$185.31 ,$447.75 ,$417.90 ,$441.78 ,$441.78 ,$463.28 ,$507.45 ,$185.31 ,$185.31 ,$418.50 ,$185.31 ,$248.35 , N/A ,$507.45 ,$398.42 ,$167.16 ,$537.30 ,$175.00 ,$185.31 ,$388.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000014,94002,HC VENT WEANING FIRST DAY,410,1 ,$996.00 ,$647.40 ,$175.00 ,"$1,200.71 ",$647.40 ,$480.29 ,$278.88 ,$503.98 ,$480.29 ,$572.70 ,$480.29 ,$503.88 ,$480.29 ,$912.54 ,$816.72 ,"$1,200.71 ",$480.29 ,$846.60 ,$896.40 ,$480.29 ,$747.00 ,$697.20 ,$737.04 ,$737.04 ,$996.00 ,$846.60 ,$480.29 ,$480.29 ,$698.20 ,$480.29 ,$414.34 , N/A ,$846.60 ,"$1,032.61 ",$278.88 ,$896.40 ,$175.00 ,$480.29 ,$647.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000015,94002,HC VENT NEONATAL INTL DAY,410,1 ,$996.00 ,$647.40 ,$175.00 ,"$1,200.71 ",$647.40 ,$480.29 ,$278.88 ,$503.98 ,$480.29 ,$572.70 ,$480.29 ,$503.88 ,$480.29 ,$912.54 ,$816.72 ,"$1,200.71 ",$480.29 ,$846.60 ,$896.40 ,$480.29 ,$747.00 ,$697.20 ,$737.04 ,$737.04 ,$996.00 ,$846.60 ,$480.29 ,$480.29 ,$698.20 ,$480.29 ,$414.34 , N/A ,$846.60 ,"$1,032.61 ",$278.88 ,$896.40 ,$175.00 ,$480.29 ,$647.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,"$1,382.00 ",$898.30 ,$175.00 ,"$1,382.00 ",$898.30 ,$480.29 ,$386.96 ,$699.29 ,$480.29 ,$794.65 ,$480.29 ,$699.15 ,$480.29 ,$912.54 ,"$1,133.24 ","$1,200.71 ",$480.29 ,"$1,174.70 ","$1,243.80 ",$480.29 ,"$1,036.50 ",$967.40 ,"$1,022.68 ","$1,022.68 ","$1,200.71 ","$1,174.70 ",$480.29 ,$480.29 ,$968.78 ,$480.29 ,$574.91 , N/A ,"$1,174.70 ","$1,032.61 ",$386.96 ,"$1,243.80 ",$175.00 ,$480.29 ,$898.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$597.00 ,$388.05 ,$167.16 ,$597.00 ,$388.05 ,$185.31 ,$167.16 ,$302.08 ,$185.31 ,$343.28 ,$185.31 ,$302.02 ,$185.31 ,$352.09 ,$489.54 ,$463.28 ,$185.31 ,$507.45 ,$537.30 ,$185.31 ,$447.75 ,$417.90 ,$441.78 ,$441.78 ,$463.28 ,$507.45 ,$185.31 ,$185.31 ,$418.50 ,$185.31 ,$248.35 , N/A ,$507.45 ,$398.42 ,$167.16 ,$537.30 ,$175.00 ,$185.31 ,$388.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000034,94640,HC IPPB,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000037,94640,HC INCENTIVE SPIROMETER TRT,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000040,94640,HC EZ PAP TREATMENT,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000046,94640,HC HIGH EFF NEB AERO EACH,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$354.00 ,$230.10 ,$99.12 ,$354.00 ,$230.10 ,$111.17 ,$99.12 ,$179.12 ,$111.17 ,$203.55 ,$111.17 ,$179.09 ,$111.17 ,$211.22 ,$290.28 ,$277.92 ,$111.17 ,$300.90 ,$318.60 ,$111.17 ,$265.50 ,$247.80 ,$261.96 ,$261.96 ,$277.92 ,$300.90 ,$111.17 ,$111.17 ,$248.15 ,$111.17 ,$147.26 , N/A ,$300.90 ,$239.01 ,$99.12 ,$318.60 ,$175.00 ,$111.17 ,$230.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$317.00 ,$206.05 ,$88.76 ,$317.00 ,$206.05 , N/A ,$88.76 ,$160.40 , N/A ,$182.28 , N/A ,$160.37 , N/A , N/A ,$259.94 , N/A , N/A ,$269.45 ,$285.30 , N/A ,$237.75 ,$221.90 ,$234.58 ,$234.58 , N/A ,$269.45 , N/A , N/A ,$222.22 , N/A ,$131.87 , N/A ,$269.45 , N/A ,$88.76 ,$285.30 ,$175.00 , N/A ,$206.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000052,94660,HC CPAP,410,1 ,$597.00 ,$388.05 ,$167.16 ,$597.00 ,$388.05 ,$185.31 ,$167.16 ,$302.08 ,$185.31 ,$343.28 ,$185.31 ,$302.02 ,$185.31 ,$352.09 ,$489.54 ,$463.28 ,$185.31 ,$507.45 ,$537.30 ,$185.31 ,$447.75 ,$417.90 ,$441.78 ,$441.78 ,$463.28 ,$507.45 ,$185.31 ,$185.31 ,$418.50 ,$185.31 ,$248.35 , N/A ,$507.45 ,$398.42 ,$167.16 ,$537.30 ,$175.00 ,$185.31 ,$388.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000053,94660,HC CPAP DAILY EST PT,410,1 ,$597.00 ,$388.05 ,$167.16 ,$597.00 ,$388.05 ,$185.31 ,$167.16 ,$302.08 ,$185.31 ,$343.28 ,$185.31 ,$302.02 ,$185.31 ,$352.09 ,$489.54 ,$463.28 ,$185.31 ,$507.45 ,$537.30 ,$185.31 ,$447.75 ,$417.90 ,$441.78 ,$441.78 ,$463.28 ,$507.45 ,$185.31 ,$185.31 ,$418.50 ,$185.31 ,$248.35 , N/A ,$507.45 ,$398.42 ,$167.16 ,$537.30 ,$175.00 ,$185.31 ,$388.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$535.00 ,$347.75 ,$149.80 ,$535.00 ,$347.75 ,$185.31 ,$149.80 ,$270.71 ,$185.31 ,$307.63 ,$185.31 ,$270.66 ,$185.31 ,$352.09 ,$438.70 ,$463.28 ,$185.31 ,$454.75 ,$481.50 ,$185.31 ,$401.25 ,$374.50 ,$395.90 ,$395.90 ,$463.28 ,$454.75 ,$185.31 ,$185.31 ,$375.04 ,$185.31 ,$222.56 , N/A ,$454.75 ,$398.42 ,$149.80 ,$481.50 ,$175.00 ,$185.31 ,$347.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$319.00 ,$207.35 ,$89.32 ,$319.00 ,$207.35 ,$111.17 ,$89.32 ,$161.41 ,$111.17 ,$183.43 ,$111.17 ,$161.38 ,$111.17 ,$211.22 ,$261.58 ,$277.92 ,$111.17 ,$271.15 ,$287.10 ,$111.17 ,$239.25 ,$223.30 ,$236.06 ,$236.06 ,$277.92 ,$271.15 ,$111.17 ,$111.17 ,$223.62 ,$111.17 ,$132.70 , N/A ,$271.15 ,$239.01 ,$89.32 ,$287.10 ,$175.00 ,$111.17 ,$207.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$141.00 ,$91.65 ,$39.48 ,$277.92 ,$91.65 ,$111.17 ,$39.48 ,$71.35 ,$111.17 ,$81.08 ,$111.17 ,$71.33 ,$111.17 ,$141.00 ,$115.62 ,$277.92 ,$111.17 ,$119.85 ,$126.90 ,$111.17 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$111.17 ,$111.17 ,$98.84 ,$111.17 ,$58.66 , N/A ,$119.85 ,$239.01 ,$39.48 ,$126.90 ,$141.00 ,$111.17 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000074,94640,HC IPPB SUBSQ,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000075,94640,HC IPV INIT,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000076,94640,HC NEBULIZER SUBSQ,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000077,94762,HC PULSE OX PER DAY,410,1 ,$419.00 ,$272.35 ,$117.32 ,$419.00 ,$272.35 ,$137.65 ,$117.32 ,$212.01 ,$137.65 ,$240.93 ,$137.65 ,$211.97 ,$137.65 ,$261.53 ,$343.58 ,$344.11 ,$137.65 ,$356.15 ,$377.10 ,$137.65 ,$314.25 ,$293.30 ,$310.06 ,$310.06 ,$344.11 ,$356.15 ,$137.65 ,$137.65 ,$293.72 ,$137.65 ,$174.30 , N/A ,$356.15 ,$295.94 ,$117.32 ,$377.10 ,$175.00 ,$137.65 ,$272.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000082,94640,HC EZPAP TREATMENT SUBSQ,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$597.00 ,$388.05 ,$167.16 ,$597.00 ,$388.05 ,$185.31 ,$167.16 ,$302.08 ,$185.31 ,$343.28 ,$185.31 ,$302.02 ,$185.31 ,$352.09 ,$489.54 ,$463.28 ,$185.31 ,$507.45 ,$537.30 ,$185.31 ,$447.75 ,$417.90 ,$441.78 ,$441.78 ,$463.28 ,$507.45 ,$185.31 ,$185.31 ,$418.50 ,$185.31 ,$248.35 , N/A ,$507.45 ,$398.42 ,$167.16 ,$537.30 ,$175.00 ,$185.31 ,$388.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),41000092,94640,HC AEROSOL INHALATION SUBSQ,410,1 ,$141.00 ,$91.65 ,$39.48 ,$463.28 ,$91.65 ,$185.31 ,$39.48 ,$71.35 ,$185.31 ,$81.08 ,$141.00 ,$71.33 ,$141.00 ,$141.00 ,$115.62 ,$463.28 ,$185.31 ,$119.85 ,$126.90 ,$185.31 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$141.00 ,$119.85 ,$185.31 ,$185.31 ,$98.84 ,$185.31 ,$58.66 , N/A ,$119.85 ,$398.42 ,$39.48 ,$126.90 ,$141.00 ,$185.31 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000018,97022,HC WHIRLPOOL 45 MINUTES,420,1 ,$150.00 ,$97.50 ,$17.22 ,$150.00 ,$97.50 ,$17.22 ,$42.00 ,$75.90 ,$17.22 ,$86.25 ,$17.22 ,$75.89 ,$17.22 ,$32.72 ,$123.00 ,$43.05 ,$17.22 ,$127.50 ,$135.00 ,$17.22 ,$112.50 ,$105.00 ,$111.00 ,$111.00 ,$43.05 ,$127.50 ,$17.22 ,$17.22 ,$105.15 ,$17.22 ,$62.40 , N/A ,$127.50 ,$37.02 ,$42.00 ,$135.00 ,$150.00 ,$17.22 ,$97.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$113.00 ,$73.45 ,$14.77 ,$113.00 ,$73.45 ,$14.77 ,$31.64 ,$57.18 ,$14.77 ,$64.98 ,$14.77 ,$57.17 ,$14.77 ,$28.06 ,$92.66 ,$36.93 ,$14.77 ,$96.05 ,$101.70 ,$14.77 ,$84.75 ,$79.10 ,$83.62 ,$83.62 ,$36.93 ,$96.05 ,$14.77 ,$14.77 ,$79.21 ,$14.77 ,$47.01 , N/A ,$96.05 ,$31.76 ,$31.64 ,$101.70 ,$113.00 ,$14.77 ,$73.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$141.00 ,$91.65 ,$19.68 ,$141.00 ,$91.65 ,$19.68 ,$39.48 ,$71.35 ,$19.68 ,$81.08 ,$19.68 ,$71.33 ,$19.68 ,$37.39 ,$115.62 ,$49.20 ,$19.68 ,$119.85 ,$126.90 ,$19.68 ,$105.75 ,$98.70 ,$104.34 ,$104.34 ,$49.20 ,$119.85 ,$19.68 ,$19.68 ,$98.84 ,$19.68 ,$58.66 , N/A ,$119.85 ,$42.31 ,$39.48 ,$126.90 ,$141.00 ,$19.68 ,$91.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$101.00 ,$65.65 ,$14.36 ,$101.00 ,$65.65 ,$14.36 ,$28.28 ,$51.11 ,$14.36 ,$58.08 ,$14.36 ,$51.10 ,$14.36 ,$27.28 ,$82.82 ,$35.90 ,$14.36 ,$85.85 ,$90.90 ,$14.36 ,$75.75 ,$70.70 ,$74.74 ,$74.74 ,$35.90 ,$85.85 ,$14.36 ,$14.36 ,$70.80 ,$14.36 ,$42.02 , N/A ,$85.85 ,$30.87 ,$28.28 ,$90.90 ,$101.00 ,$14.36 ,$65.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$116.00 ,$75.40 ,$29.76 ,$116.00 ,$75.40 ,$29.76 ,$32.48 ,$58.70 ,$29.76 ,$66.70 ,$29.76 ,$58.68 ,$29.76 ,$56.54 ,$95.12 ,$74.40 ,$29.76 ,$98.60 ,$104.40 ,$29.76 ,$87.00 ,$81.20 ,$85.84 ,$85.84 ,$74.40 ,$98.60 ,$29.76 ,$29.76 ,$81.32 ,$29.76 ,$48.26 , N/A ,$98.60 ,$63.98 ,$32.48 ,$104.40 ,$116.00 ,$29.76 ,$75.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$106.00 ,$68.90 ,$29.68 ,$106.00 ,$68.90 ,$34.43 ,$29.68 ,$53.64 ,$34.43 ,$60.95 ,$34.43 ,$53.63 ,$34.43 ,$65.42 ,$86.92 ,$86.08 ,$34.43 ,$90.10 ,$95.40 ,$34.43 ,$79.50 ,$74.20 ,$78.44 ,$78.44 ,$86.08 ,$90.10 ,$34.43 ,$34.43 ,$74.31 ,$34.43 ,$44.10 , N/A ,$90.10 ,$74.02 ,$29.68 ,$95.40 ,$106.00 ,$34.43 ,$68.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$108.00 ,$70.20 ,$29.76 ,$108.00 ,$70.20 ,$29.76 ,$30.24 ,$54.65 ,$29.76 ,$62.10 ,$29.76 ,$54.64 ,$29.76 ,$56.54 ,$88.56 ,$74.40 ,$29.76 ,$91.80 ,$97.20 ,$29.76 ,$81.00 ,$75.60 ,$79.92 ,$79.92 ,$74.40 ,$91.80 ,$29.76 ,$29.76 ,$75.71 ,$29.76 ,$44.93 , N/A ,$91.80 ,$63.98 ,$30.24 ,$97.20 ,$108.00 ,$29.76 ,$70.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$125.00 ,$81.25 ,$29.64 ,$125.00 ,$81.25 ,$29.64 ,$35.00 ,$63.25 ,$29.64 ,$71.88 ,$29.64 ,$63.24 ,$29.64 ,$56.32 ,$102.50 ,$74.10 ,$29.64 ,$106.25 ,$112.50 ,$29.64 ,$93.75 ,$87.50 ,$92.50 ,$92.50 ,$74.10 ,$106.25 ,$29.64 ,$29.64 ,$87.63 ,$29.64 ,$52.00 , N/A ,$106.25 ,$63.73 ,$35.00 ,$112.50 ,$125.00 ,$29.64 ,$81.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$119.00 ,$77.35 ,$27.44 ,$119.00 ,$77.35 ,$27.44 ,$33.32 ,$60.21 ,$27.44 ,$68.43 ,$27.44 ,$60.20 ,$27.44 ,$52.14 ,$97.58 ,$68.60 ,$27.44 ,$101.15 ,$107.10 ,$27.44 ,$89.25 ,$83.30 ,$88.06 ,$88.06 ,$68.60 ,$101.15 ,$27.44 ,$27.44 ,$83.42 ,$27.44 ,$49.50 , N/A ,$101.15 ,$59.00 ,$33.32 ,$107.10 ,$119.00 ,$27.44 ,$77.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$130.00 ,$84.50 ,$36.40 ,$130.00 ,$84.50 ,$37.24 ,$36.40 ,$65.78 ,$37.24 ,$74.75 ,$37.24 ,$65.77 ,$37.24 ,$70.76 ,$106.60 ,$93.10 ,$37.24 ,$110.50 ,$117.00 ,$37.24 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$93.10 ,$110.50 ,$37.24 ,$37.24 ,$91.13 ,$37.24 ,$54.08 , N/A ,$110.50 ,$80.07 ,$36.40 ,$117.00 ,$130.00 ,$37.24 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000084,97602,HC DEBRIDEMENT NONSELECTIVE,420,1 ,$302.00 ,$196.30 ,$84.56 ,$302.00 ,$196.30 , N/A ,$84.56 ,$152.81 , N/A ,$173.65 , N/A ,$152.78 , N/A , N/A ,$247.64 , N/A , N/A ,$256.70 ,$271.80 , N/A ,$226.50 ,$211.40 ,$223.48 ,$223.48 , N/A ,$256.70 , N/A , N/A ,$211.70 , N/A ,$125.63 , N/A ,$256.70 , N/A ,$84.56 ,$271.80 ,$190.00 , N/A ,$196.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$302.00 ,$196.30 ,$42.35 ,$302.00 ,$196.30 ,$42.35 ,$84.56 ,$152.81 ,$42.35 ,$173.65 ,$42.35 ,$152.78 ,$42.35 ,$80.47 ,$247.64 ,$105.88 ,$42.35 ,$256.70 ,$271.80 ,$42.35 ,$226.50 ,$211.40 ,$223.48 ,$223.48 ,$105.88 ,$256.70 ,$42.35 ,$42.35 ,$211.70 ,$42.35 ,$125.63 , N/A ,$256.70 ,$91.05 ,$84.56 ,$271.80 ,$190.00 ,$42.35 ,$196.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$526.00 ,$341.90 ,$49.95 ,$526.00 ,$341.90 ,$49.95 ,$147.28 ,$266.16 ,$49.95 ,$302.45 ,$49.95 ,$266.10 ,$49.95 ,$94.91 ,$431.32 ,$124.88 ,$49.95 ,$447.10 ,$473.40 ,$49.95 ,$394.50 ,$368.20 ,$389.24 ,$389.24 ,$124.88 ,$447.10 ,$49.95 ,$49.95 ,$368.73 ,$49.95 ,$218.82 , N/A ,$447.10 ,$107.39 ,$147.28 ,$473.40 ,$190.00 ,$49.95 ,$341.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$128.00 ,$83.20 ,$33.67 ,$128.00 ,$83.20 ,$33.67 ,$35.84 ,$64.77 ,$33.67 ,$73.60 ,$33.67 ,$64.76 ,$33.67 ,$63.97 ,$104.96 ,$84.18 ,$33.67 ,$108.80 ,$115.20 ,$33.67 ,$96.00 ,$89.60 ,$94.72 ,$94.72 ,$84.18 ,$108.80 ,$33.67 ,$33.67 ,$89.73 ,$33.67 ,$53.25 , N/A ,$108.80 ,$72.39 ,$35.84 ,$115.20 ,$128.00 ,$33.67 ,$83.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$145.00 ,$94.25 ,$40.60 ,$145.00 ,$94.25 ,$41.60 ,$40.60 ,$73.37 ,$41.60 ,$83.38 ,$41.60 ,$73.36 ,$41.60 ,$79.04 ,$118.90 ,$104.00 ,$41.60 ,$123.25 ,$130.50 ,$41.60 ,$108.75 ,$101.50 ,$107.30 ,$107.30 ,$104.00 ,$123.25 ,$41.60 ,$41.60 ,$101.65 ,$41.60 ,$60.32 , N/A ,$123.25 ,$89.44 ,$40.60 ,$130.50 ,$145.00 ,$41.60 ,$94.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000151,29581,HC APPL MULTI COMP WRAP PT/OT,420,1 ,$402.00 ,$261.30 ,$112.56 ,$402.00 ,$261.30 ,$139.29 ,$112.56 ,$203.41 ,$139.29 ,$231.15 ,$139.29 ,$203.37 ,$139.29 ,$264.64 ,$329.64 ,$348.22 ,$139.29 ,$341.70 ,$361.80 ,$139.29 ,$301.50 ,$281.40 ,$297.48 ,$297.48 ,$348.22 ,$341.70 ,$139.29 ,$139.29 ,$281.80 ,$139.29 ,$167.23 , N/A ,$341.70 ,$299.46 ,$112.56 ,$361.80 ,$190.00 ,$139.29 ,$261.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000206,G0283,HC ELECT STIM (UNATTEND) OTHER 15MIN,420,1 ,$123.00 ,$79.95 ,$12.35 ,$123.00 ,$79.95 ,$12.35 ,$34.44 ,$62.24 ,$12.35 ,$70.73 ,$12.35 ,$62.23 ,$12.35 ,$23.47 ,$100.86 ,$30.88 ,$12.35 ,$104.55 ,$110.70 ,$12.35 ,$92.25 ,$86.10 ,$91.02 ,$91.02 ,$30.88 ,$104.55 ,$12.35 ,$12.35 ,$86.22 ,$12.35 ,$51.17 , N/A ,$104.55 ,$26.55 ,$34.44 ,$110.70 ,$123.00 ,$12.35 ,$79.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000207,G0283,HC ELECT STIM (UNATTEND) OTHER 30MIN,420,1 ,$123.00 ,$79.95 ,$12.35 ,$123.00 ,$79.95 ,$12.35 ,$34.44 ,$62.24 ,$12.35 ,$70.73 ,$12.35 ,$62.23 ,$12.35 ,$23.47 ,$100.86 ,$30.88 ,$12.35 ,$104.55 ,$110.70 ,$12.35 ,$92.25 ,$86.10 ,$91.02 ,$91.02 ,$30.88 ,$104.55 ,$12.35 ,$12.35 ,$86.22 ,$12.35 ,$51.17 , N/A ,$104.55 ,$26.55 ,$34.44 ,$110.70 ,$123.00 ,$12.35 ,$79.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000208,G0283,HC ELECT STIM (UNATTEND) OTHER 45MIN,420,1 ,$123.00 ,$79.95 ,$12.35 ,$123.00 ,$79.95 ,$12.35 ,$34.44 ,$62.24 ,$12.35 ,$70.73 ,$12.35 ,$62.23 ,$12.35 ,$23.47 ,$100.86 ,$30.88 ,$12.35 ,$104.55 ,$110.70 ,$12.35 ,$92.25 ,$86.10 ,$91.02 ,$91.02 ,$30.88 ,$104.55 ,$12.35 ,$12.35 ,$86.22 ,$12.35 ,$51.17 , N/A ,$104.55 ,$26.55 ,$34.44 ,$110.70 ,$123.00 ,$12.35 ,$79.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000209,G0283,HC ELECT STIM (UNATTEND) OTHER 60MIN,420,1 ,$123.00 ,$79.95 ,$12.35 ,$123.00 ,$79.95 ,$12.35 ,$34.44 ,$62.24 ,$12.35 ,$70.73 ,$12.35 ,$62.23 ,$12.35 ,$23.47 ,$100.86 ,$30.88 ,$12.35 ,$104.55 ,$110.70 ,$12.35 ,$92.25 ,$86.10 ,$91.02 ,$91.02 ,$30.88 ,$104.55 ,$12.35 ,$12.35 ,$86.22 ,$12.35 ,$51.17 , N/A ,$104.55 ,$26.55 ,$34.44 ,$110.70 ,$123.00 ,$12.35 ,$79.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000210,97016,HC APPLY VASOPNEUMATIC DEVICE 15MIN,420,1 ,$112.00 ,$72.80 ,$12.02 ,$112.00 ,$72.80 ,$12.02 ,$31.36 ,$56.67 ,$12.02 ,$64.40 ,$12.02 ,$56.66 ,$12.02 ,$22.84 ,$91.84 ,$30.05 ,$12.02 ,$95.20 ,$100.80 ,$12.02 ,$84.00 ,$78.40 ,$82.88 ,$82.88 ,$30.05 ,$95.20 ,$12.02 ,$12.02 ,$78.51 ,$12.02 ,$46.59 , N/A ,$95.20 ,$25.84 ,$31.36 ,$100.80 ,$112.00 ,$12.02 ,$72.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000211,97016,HC APPLY VASOPNEUMATIC DEVICE 30MIN,420,1 ,$112.00 ,$72.80 ,$12.02 ,$112.00 ,$72.80 ,$12.02 ,$31.36 ,$56.67 ,$12.02 ,$64.40 ,$12.02 ,$56.66 ,$12.02 ,$22.84 ,$91.84 ,$30.05 ,$12.02 ,$95.20 ,$100.80 ,$12.02 ,$84.00 ,$78.40 ,$82.88 ,$82.88 ,$30.05 ,$95.20 ,$12.02 ,$12.02 ,$78.51 ,$12.02 ,$46.59 , N/A ,$95.20 ,$25.84 ,$31.36 ,$100.80 ,$112.00 ,$12.02 ,$72.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000212,97016,HC APPLY VASOPNEUMATIC DEVICE 45MIN,420,1 ,$112.00 ,$72.80 ,$12.02 ,$112.00 ,$72.80 ,$12.02 ,$31.36 ,$56.67 ,$12.02 ,$64.40 ,$12.02 ,$56.66 ,$12.02 ,$22.84 ,$91.84 ,$30.05 ,$12.02 ,$95.20 ,$100.80 ,$12.02 ,$84.00 ,$78.40 ,$82.88 ,$82.88 ,$30.05 ,$95.20 ,$12.02 ,$12.02 ,$78.51 ,$12.02 ,$46.59 , N/A ,$95.20 ,$25.84 ,$31.36 ,$100.80 ,$112.00 ,$12.02 ,$72.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000213,97016,HC APPLY VASOPNEUMATIC DEVICE 60MIN,420,1 ,$112.00 ,$72.80 ,$12.02 ,$112.00 ,$72.80 ,$12.02 ,$31.36 ,$56.67 ,$12.02 ,$64.40 ,$12.02 ,$56.66 ,$12.02 ,$22.84 ,$91.84 ,$30.05 ,$12.02 ,$95.20 ,$100.80 ,$12.02 ,$84.00 ,$78.40 ,$82.88 ,$82.88 ,$30.05 ,$95.20 ,$12.02 ,$12.02 ,$78.51 ,$12.02 ,$46.59 , N/A ,$95.20 ,$25.84 ,$31.36 ,$100.80 ,$112.00 ,$12.02 ,$72.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000214,97012,HC TRACTION MECHANICAL APPL 15 MIN,420,1 ,$132.00 ,$85.80 ,$14.44 ,$132.00 ,$85.80 ,$14.44 ,$36.96 ,$66.79 ,$14.44 ,$75.90 ,$14.44 ,$66.78 ,$14.44 ,$27.44 ,$108.24 ,$36.10 ,$14.44 ,$112.20 ,$118.80 ,$14.44 ,$99.00 ,$92.40 ,$97.68 ,$97.68 ,$36.10 ,$112.20 ,$14.44 ,$14.44 ,$92.53 ,$14.44 ,$54.91 , N/A ,$112.20 ,$31.05 ,$36.96 ,$118.80 ,$132.00 ,$14.44 ,$85.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000215,97012,HC TRACTION MECHANICAL APPL 30 MIN,420,1 ,$132.00 ,$85.80 ,$14.44 ,$132.00 ,$85.80 ,$14.44 ,$36.96 ,$66.79 ,$14.44 ,$75.90 ,$14.44 ,$66.78 ,$14.44 ,$27.44 ,$108.24 ,$36.10 ,$14.44 ,$112.20 ,$118.80 ,$14.44 ,$99.00 ,$92.40 ,$97.68 ,$97.68 ,$36.10 ,$112.20 ,$14.44 ,$14.44 ,$92.53 ,$14.44 ,$54.91 , N/A ,$112.20 ,$31.05 ,$36.96 ,$118.80 ,$132.00 ,$14.44 ,$85.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000218,97014,HC ELEC STIM UNATTENDED 15MIN,420,1 ,$100.00 ,$65.00 ,$28.00 ,$100.00 ,$65.00 , N/A ,$28.00 ,$50.60 , N/A ,$57.50 , N/A ,$50.59 , N/A , N/A ,$82.00 , N/A , N/A ,$85.00 ,$90.00 , N/A ,$75.00 ,$70.00 ,$74.00 ,$74.00 , N/A ,$85.00 , N/A , N/A ,$70.10 , N/A ,$41.60 , N/A ,$85.00 , N/A ,$28.00 ,$90.00 ,$100.00 , N/A ,$65.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000267,N/A,HC THERAPY ASSESSMENT - SELF PAY,420,1 ,$125.00 ,$81.25 ,$35.00 ,$125.00 ,$81.25 , N/A ,$35.00 ,$63.25 , N/A ,$71.88 , N/A ,$63.24 , N/A , N/A ,$102.50 , N/A , N/A ,$106.25 ,$112.50 , N/A ,$93.75 ,$87.50 ,$92.50 ,$92.50 , N/A ,$106.25 , N/A , N/A ,$87.63 , N/A ,$52.00 , N/A ,$106.25 , N/A ,$35.00 ,$112.50 ,$125.00 , N/A ,$81.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42000268,N/A,HC THERAPY TREATMENT 30MIN - SELF PAY,420,1 ,$75.00 ,$48.75 ,$21.00 ,$75.00 ,$48.75 , N/A ,$21.00 ,$37.95 , N/A ,$43.13 , N/A ,$37.94 , N/A , N/A ,$61.50 , N/A , N/A ,$63.75 ,$67.50 , N/A ,$56.25 ,$52.50 ,$55.50 ,$55.50 , N/A ,$63.75 , N/A , N/A ,$52.58 , N/A ,$31.20 , N/A ,$63.75 , N/A ,$21.00 ,$67.50 ,$75.00 , N/A ,$48.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400047,97161,HC PT EVAL LOW COMPLEXITY 75MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400048,97161,HC PT EVAL LOW COMPLEXITY 90MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400049,97161,HC PT EVAL LOW COMPLEXITY 105MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400050,97161,HC PT EVAL LOW COMPLEXITY 120MIN,424,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$190.00 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400059,97162,HC PT EVAL MOD COMPLEXITY 75MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400060,97162,HC PT EVAL MOD COMPLEXITY 90MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400061,97162,HC PT EVAL MOD COMPLEXITY 105MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400062,97162,HC PT EVAL MOD COMPLEXITY 120MIN,424,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$190.00 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400071,97163,HC PT EVAL HIGH COMPLEXITY 75MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400072,97163,HC PT EVAL HIGH COMPLEXITY 90MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400073,97163,HC PT EVAL HIGH COMPLEXITY 105MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400074,97163,HC PT EVAL HIGH COMPLEXITY 120MIN,424,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$190.00 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$224.00 ,$145.60 ,$62.72 ,$224.00 ,$145.60 ,$69.42 ,$62.72 ,$113.34 ,$69.42 ,$128.80 ,$69.42 ,$113.32 ,$69.42 ,$131.90 ,$183.68 ,$173.55 ,$69.42 ,$190.40 ,$201.60 ,$69.42 ,$168.00 ,$156.80 ,$165.76 ,$165.76 ,$173.55 ,$190.40 ,$69.42 ,$69.42 ,$157.02 ,$69.42 ,$93.18 , N/A ,$190.40 ,$149.25 ,$62.72 ,$201.60 ,$190.00 ,$69.42 ,$145.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$224.00 ,$145.60 ,$62.72 ,$224.00 ,$145.60 ,$69.42 ,$62.72 ,$113.34 ,$69.42 ,$128.80 ,$69.42 ,$113.32 ,$69.42 ,$131.90 ,$183.68 ,$173.55 ,$69.42 ,$190.40 ,$201.60 ,$69.42 ,$168.00 ,$156.80 ,$165.76 ,$165.76 ,$173.55 ,$190.40 ,$69.42 ,$69.42 ,$157.02 ,$69.42 ,$93.18 , N/A ,$190.40 ,$149.25 ,$62.72 ,$201.60 ,$190.00 ,$69.42 ,$145.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$224.00 ,$145.60 ,$62.72 ,$224.00 ,$145.60 ,$69.42 ,$62.72 ,$113.34 ,$69.42 ,$128.80 ,$69.42 ,$113.32 ,$69.42 ,$131.90 ,$183.68 ,$173.55 ,$69.42 ,$190.40 ,$201.60 ,$69.42 ,$168.00 ,$156.80 ,$165.76 ,$165.76 ,$173.55 ,$190.40 ,$69.42 ,$69.42 ,$157.02 ,$69.42 ,$93.18 , N/A ,$190.40 ,$149.25 ,$62.72 ,$201.60 ,$190.00 ,$69.42 ,$145.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$224.00 ,$145.60 ,$62.72 ,$224.00 ,$145.60 ,$69.42 ,$62.72 ,$113.34 ,$69.42 ,$128.80 ,$69.42 ,$113.32 ,$69.42 ,$131.90 ,$183.68 ,$173.55 ,$69.42 ,$190.40 ,$201.60 ,$69.42 ,$168.00 ,$156.80 ,$165.76 ,$165.76 ,$173.55 ,$190.40 ,$69.42 ,$69.42 ,$157.02 ,$69.42 ,$93.18 , N/A ,$190.40 ,$149.25 ,$62.72 ,$201.60 ,$190.00 ,$69.42 ,$145.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000015,97533,HC PERCEPTUAL ACTIVITY EA 15 MIN,430,1 ,$130.00 ,$84.50 ,$36.40 ,$159.33 ,$84.50 ,$63.73 ,$36.40 ,$65.78 ,$63.73 ,$74.75 ,$63.73 ,$65.77 ,$63.73 ,$121.09 ,$106.60 ,$159.33 ,$63.73 ,$110.50 ,$117.00 ,$63.73 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$130.00 ,$110.50 ,$63.73 ,$63.73 ,$91.13 ,$63.73 ,$54.08 , N/A ,$110.50 ,$137.02 ,$36.40 ,$117.00 ,$130.00 ,$63.73 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$130.00 ,$84.50 ,$33.02 ,$130.00 ,$84.50 ,$33.02 ,$36.40 ,$65.78 ,$33.02 ,$74.75 ,$33.02 ,$65.77 ,$33.02 ,$62.74 ,$106.60 ,$82.55 ,$33.02 ,$110.50 ,$117.00 ,$33.02 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$82.55 ,$110.50 ,$33.02 ,$33.02 ,$91.13 ,$33.02 ,$54.08 , N/A ,$110.50 ,$70.99 ,$36.40 ,$117.00 ,$130.00 ,$33.02 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000024,97542,HC SEATING CLINIC EA 15 MIN,430,1 ,$118.00 ,$76.70 ,$32.10 ,$118.00 ,$76.70 ,$32.10 ,$33.04 ,$59.71 ,$32.10 ,$67.85 ,$32.10 ,$59.70 ,$32.10 ,$60.99 ,$96.76 ,$80.25 ,$32.10 ,$100.30 ,$106.20 ,$32.10 ,$88.50 ,$82.60 ,$87.32 ,$87.32 ,$80.25 ,$100.30 ,$32.10 ,$32.10 ,$82.72 ,$32.10 ,$49.09 , N/A ,$100.30 ,$69.02 ,$33.04 ,$106.20 ,$118.00 ,$32.10 ,$76.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$159.00 ,$103.35 ,$44.52 ,$159.00 ,$103.35 ,$48.44 ,$44.52 ,$80.45 ,$48.44 ,$91.43 ,$48.44 ,$80.44 ,$48.44 ,$92.04 ,$130.38 ,$121.10 ,$48.44 ,$135.15 ,$143.10 ,$48.44 ,$119.25 ,$111.30 ,$117.66 ,$117.66 ,$121.10 ,$135.15 ,$48.44 ,$48.44 ,$111.46 ,$48.44 ,$66.14 , N/A ,$135.15 ,$104.15 ,$44.52 ,$143.10 ,$159.00 ,$48.44 ,$103.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000035,97545,HC WORK HARDENING/CONDITIONING FIRST 2 HRS,430,1 ,$778.00 ,$505.70 ,$190.00 ,$778.00 ,$505.70 , N/A ,$217.84 ,$393.67 , N/A ,$447.35 , N/A ,$393.59 , N/A , N/A ,$637.96 , N/A , N/A ,$661.30 ,$700.20 , N/A ,$583.50 ,$544.60 ,$575.72 ,$575.72 , N/A ,$661.30 , N/A , N/A ,$545.38 , N/A ,$323.65 , N/A ,$661.30 , N/A ,$217.84 ,$700.20 ,$190.00 , N/A ,$505.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000036,97546,HC WORK HARDENING/CONDITIONINS ADD 1 HOUR,430,1 ,$149.00 ,$96.85 ,$41.72 ,$149.00 ,$96.85 , N/A ,$41.72 ,$75.39 , N/A ,$85.68 , N/A ,$75.38 , N/A , N/A ,$122.18 , N/A , N/A ,$126.65 ,$134.10 , N/A ,$111.75 ,$104.30 ,$110.26 ,$110.26 , N/A ,$126.65 , N/A , N/A ,$104.45 , N/A ,$61.98 , N/A ,$126.65 , N/A ,$41.72 ,$134.10 ,$149.00 , N/A ,$96.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000038,97018,HC PARAFFIN BATH THERAPY 15MIN,430,1 ,$79.00 ,$51.35 ,$5.91 ,$79.00 ,$51.35 ,$5.91 ,$22.12 ,$39.97 ,$5.91 ,$45.43 ,$5.91 ,$39.97 ,$5.91 ,$11.23 ,$64.78 ,$14.78 ,$5.91 ,$67.15 ,$71.10 ,$5.91 ,$59.25 ,$55.30 ,$58.46 ,$58.46 ,$14.78 ,$67.15 ,$5.91 ,$5.91 ,$55.38 ,$5.91 ,$32.86 , N/A ,$67.15 ,$12.71 ,$22.12 ,$71.10 ,$79.00 ,$5.91 ,$51.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000039,97018,HC PARAFFIN BATH THERAPY 30MIN,430,1 ,$79.00 ,$51.35 ,$5.91 ,$79.00 ,$51.35 ,$5.91 ,$22.12 ,$39.97 ,$5.91 ,$45.43 ,$5.91 ,$39.97 ,$5.91 ,$11.23 ,$64.78 ,$14.78 ,$5.91 ,$67.15 ,$71.10 ,$5.91 ,$59.25 ,$55.30 ,$58.46 ,$58.46 ,$14.78 ,$67.15 ,$5.91 ,$5.91 ,$55.38 ,$5.91 ,$32.86 , N/A ,$67.15 ,$12.71 ,$22.12 ,$71.10 ,$79.00 ,$5.91 ,$51.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000049,95852,HC RANGE OF MOTION TESTING HAND,430,1 ,$114.00 ,$74.10 ,$17.10 ,$114.00 ,$74.10 ,$17.10 ,$31.92 ,$57.68 ,$17.10 ,$65.55 ,$17.10 ,$57.67 ,$17.10 ,$32.49 ,$93.48 ,$42.75 ,$17.10 ,$96.90 ,$102.60 ,$17.10 ,$85.50 ,$79.80 ,$84.36 ,$84.36 ,$42.75 ,$96.90 ,$17.10 ,$17.10 ,$79.91 ,$17.10 ,$47.42 , N/A ,$96.90 ,$36.77 ,$31.92 ,$102.60 ,$114.00 ,$17.10 ,$74.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$138.00 ,$89.70 ,$23.34 ,$138.00 ,$89.70 ,$23.34 ,$38.64 ,$69.83 ,$23.34 ,$79.35 ,$23.34 ,$69.81 ,$23.34 ,$44.35 ,$113.16 ,$58.35 ,$23.34 ,$117.30 ,$124.20 ,$23.34 ,$103.50 ,$96.60 ,$102.12 ,$102.12 ,$58.35 ,$117.30 ,$23.34 ,$23.34 ,$96.74 ,$23.34 ,$57.41 , N/A ,$117.30 ,$50.18 ,$38.64 ,$124.20 ,$138.00 ,$23.34 ,$89.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$129.00 ,$83.85 ,$22.65 ,$129.00 ,$83.85 ,$22.65 ,$36.12 ,$65.27 ,$22.65 ,$74.18 ,$22.65 ,$65.26 ,$22.65 ,$43.04 ,$105.78 ,$56.63 ,$22.65 ,$109.65 ,$116.10 ,$22.65 ,$96.75 ,$90.30 ,$95.46 ,$95.46 ,$56.63 ,$109.65 ,$22.65 ,$22.65 ,$90.43 ,$22.65 ,$53.66 , N/A ,$109.65 ,$48.70 ,$36.12 ,$116.10 ,$129.00 ,$22.65 ,$83.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400038,97165,HC OT EVAL LOW COMPLEXITY 75MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400039,97165,HC OT EVAL LOW COMPLEXITY 90MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400040,97165,HC OT EVAL LOW COMPLEXITY 105MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400041,97165,HC OT EVAL LOW COMPLEXITY 120MIN,434,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$190.00 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400050,97166,HC OT EVAL MOD COMPLEXITY 75MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400051,97166,HC OT EVAL MOD COMPLEXITY 90MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400052,97166,HC OT EVAL MOD COMPLEXITY 105MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400053,97166,HC OT EVAL MOD COMPLEXITY 120MIN,434,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$190.00 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400062,97167,HC OT EVAL HIGH COMPLEXITY 75MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400063,97167,HC OT EVAL HIGH COMPLEXITY 90MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400064,97167,HC OT EVAL HIGH COMPLEXITY 105MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400065,97167,HC OT EVAL HIGH COMPLEXITY 120MIN,434,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$190.00 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400074,97168,HC OT RE-EVAL 75MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400075,97168,HC OT RE-EVAL 90MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),43400076,97168,HC OT RE-EVAL 105MIN,434,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$184.00 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$190.00 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$190.00 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$190.00 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$190.00 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$190.00 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$190.00 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$190.00 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$190.00 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$336.00 ,$218.40 ,$86.50 ,$336.00 ,$218.40 ,$86.50 ,$94.08 ,$170.02 ,$86.50 ,$193.20 ,$86.50 ,$169.98 ,$86.50 ,$164.35 ,$275.52 ,$216.25 ,$86.50 ,$285.60 ,$302.40 ,$86.50 ,$252.00 ,$235.20 ,$248.64 ,$248.64 ,$216.25 ,$285.60 ,$86.50 ,$86.50 ,$235.54 ,$86.50 ,$139.78 , N/A ,$285.60 ,$185.98 ,$94.08 ,$302.40 ,$190.00 ,$86.50 ,$218.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$336.00 ,$218.40 ,$86.50 ,$336.00 ,$218.40 ,$86.50 ,$94.08 ,$170.02 ,$86.50 ,$193.20 ,$86.50 ,$169.98 ,$86.50 ,$164.35 ,$275.52 ,$216.25 ,$86.50 ,$285.60 ,$302.40 ,$86.50 ,$252.00 ,$235.20 ,$248.64 ,$248.64 ,$216.25 ,$285.60 ,$86.50 ,$86.50 ,$235.54 ,$86.50 ,$139.78 , N/A ,$285.60 ,$185.98 ,$94.08 ,$302.40 ,$190.00 ,$86.50 ,$218.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$336.00 ,$218.40 ,$86.50 ,$336.00 ,$218.40 ,$86.50 ,$94.08 ,$170.02 ,$86.50 ,$193.20 ,$86.50 ,$169.98 ,$86.50 ,$164.35 ,$275.52 ,$216.25 ,$86.50 ,$285.60 ,$302.40 ,$86.50 ,$252.00 ,$235.20 ,$248.64 ,$248.64 ,$216.25 ,$285.60 ,$86.50 ,$86.50 ,$235.54 ,$86.50 ,$139.78 , N/A ,$285.60 ,$185.98 ,$94.08 ,$302.40 ,$190.00 ,$86.50 ,$218.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$336.00 ,$218.40 ,$86.50 ,$336.00 ,$218.40 ,$86.50 ,$94.08 ,$170.02 ,$86.50 ,$193.20 ,$86.50 ,$169.98 ,$86.50 ,$164.35 ,$275.52 ,$216.25 ,$86.50 ,$285.60 ,$302.40 ,$86.50 ,$252.00 ,$235.20 ,$248.64 ,$248.64 ,$216.25 ,$285.60 ,$86.50 ,$86.50 ,$235.54 ,$86.50 ,$139.78 , N/A ,$285.60 ,$185.98 ,$94.08 ,$302.40 ,$190.00 ,$86.50 ,$218.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400029,92611,HC DYSPHAGIA EVAL-VIDEO 15MIN,444,1 ,$460.00 ,$299.00 ,$93.27 ,$460.00 ,$299.00 ,$93.27 ,$128.80 ,$232.76 ,$93.27 ,$264.50 ,$93.27 ,$232.71 ,$93.27 ,$177.21 ,$377.20 ,$233.18 ,$93.27 ,$391.00 ,$414.00 ,$93.27 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$233.18 ,$391.00 ,$93.27 ,$93.27 ,$322.46 ,$93.27 ,$191.36 , N/A ,$391.00 ,$200.53 ,$128.80 ,$414.00 ,$190.00 ,$93.27 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400030,92611,HC DYSPHAGIA EVAL-VIDEO 30MIN,444,1 ,$460.00 ,$299.00 ,$93.27 ,$460.00 ,$299.00 ,$93.27 ,$128.80 ,$232.76 ,$93.27 ,$264.50 ,$93.27 ,$232.71 ,$93.27 ,$177.21 ,$377.20 ,$233.18 ,$93.27 ,$391.00 ,$414.00 ,$93.27 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$233.18 ,$391.00 ,$93.27 ,$93.27 ,$322.46 ,$93.27 ,$191.36 , N/A ,$391.00 ,$200.53 ,$128.80 ,$414.00 ,$190.00 ,$93.27 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400031,92611,HC DYSPHAGIA EVAL-VIDEO 45MIN,444,1 ,$460.00 ,$299.00 ,$93.27 ,$460.00 ,$299.00 ,$93.27 ,$128.80 ,$232.76 ,$93.27 ,$264.50 ,$93.27 ,$232.71 ,$93.27 ,$177.21 ,$377.20 ,$233.18 ,$93.27 ,$391.00 ,$414.00 ,$93.27 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$233.18 ,$391.00 ,$93.27 ,$93.27 ,$322.46 ,$93.27 ,$191.36 , N/A ,$391.00 ,$200.53 ,$128.80 ,$414.00 ,$190.00 ,$93.27 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400032,92611,HC DYSPHAGIA EVAL-VIDEO 60MIN,444,1 ,$460.00 ,$299.00 ,$93.27 ,$460.00 ,$299.00 ,$93.27 ,$128.80 ,$232.76 ,$93.27 ,$264.50 ,$93.27 ,$232.71 ,$93.27 ,$177.21 ,$377.20 ,$233.18 ,$93.27 ,$391.00 ,$414.00 ,$93.27 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$233.18 ,$391.00 ,$93.27 ,$93.27 ,$322.46 ,$93.27 ,$191.36 , N/A ,$391.00 ,$200.53 ,$128.80 ,$414.00 ,$190.00 ,$93.27 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$460.00 ,$299.00 ,$93.27 ,$460.00 ,$299.00 ,$93.27 ,$128.80 ,$232.76 ,$93.27 ,$264.50 ,$93.27 ,$232.71 ,$93.27 ,$177.21 ,$377.20 ,$233.18 ,$93.27 ,$391.00 ,$414.00 ,$93.27 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$233.18 ,$391.00 ,$93.27 ,$93.27 ,$322.46 ,$93.27 ,$191.36 , N/A ,$391.00 ,$200.53 ,$128.80 ,$414.00 ,$190.00 ,$93.27 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400036,92611,HC DYSPHAGIA RE-EVAL VIDEO PEDS,444,1 ,$460.00 ,$299.00 ,$93.27 ,$460.00 ,$299.00 ,$93.27 ,$128.80 ,$232.76 ,$93.27 ,$264.50 ,$93.27 ,$232.71 ,$93.27 ,$177.21 ,$377.20 ,$233.18 ,$93.27 ,$391.00 ,$414.00 ,$93.27 ,$345.00 ,$322.00 ,$340.40 ,$340.40 ,$233.18 ,$391.00 ,$93.27 ,$93.27 ,$322.46 ,$93.27 ,$191.36 , N/A ,$391.00 ,$200.53 ,$128.80 ,$414.00 ,$190.00 ,$93.27 ,$299.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400040,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN,444,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$186.00 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$409.00 ,$265.85 ,$114.52 ,$571.95 ,$265.85 ,$228.78 ,$114.52 ,$206.95 ,$228.78 ,$235.18 ,$228.78 ,$206.91 ,$228.78 ,$409.00 ,$335.38 ,$571.95 ,$228.78 ,$347.65 ,$368.10 ,$228.78 ,$306.75 ,$286.30 ,$302.66 ,$302.66 ,$409.00 ,$347.65 ,$228.78 ,$228.78 ,$286.71 ,$228.78 ,$170.14 , N/A ,$347.65 ,$491.88 ,$114.52 ,$368.10 ,$190.00 ,$228.78 ,$265.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$305.00 ,$198.25 ,$85.40 ,$305.00 ,$198.25 ,$111.71 ,$85.40 ,$154.33 ,$111.71 ,$175.38 ,$111.71 ,$154.30 ,$111.71 ,$212.25 ,$250.10 ,$279.28 ,$111.71 ,$259.25 ,$274.50 ,$111.71 ,$228.75 ,$213.50 ,$225.70 ,$225.70 ,$279.28 ,$259.25 ,$111.71 ,$111.71 ,$213.81 ,$111.71 ,$126.88 , N/A ,$259.25 ,$240.18 ,$85.40 ,$274.50 ,$190.00 ,$111.71 ,$198.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$186.00 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$186.00 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400054,92521,HC EVALUATION OF SPEECH FLUENCY 60MIN,444,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$186.00 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$409.00 ,$265.85 ,$114.52 ,$571.95 ,$265.85 ,$228.78 ,$114.52 ,$206.95 ,$228.78 ,$235.18 ,$228.78 ,$206.91 ,$228.78 ,$409.00 ,$335.38 ,$571.95 ,$228.78 ,$347.65 ,$368.10 ,$228.78 ,$306.75 ,$286.30 ,$302.66 ,$302.66 ,$409.00 ,$347.65 ,$228.78 ,$228.78 ,$286.71 ,$228.78 ,$170.14 , N/A ,$347.65 ,$491.88 ,$114.52 ,$368.10 ,$190.00 ,$228.78 ,$265.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$409.00 ,$265.85 ,$114.52 ,$571.95 ,$265.85 ,$228.78 ,$114.52 ,$206.95 ,$228.78 ,$235.18 ,$228.78 ,$206.91 ,$228.78 ,$409.00 ,$335.38 ,$571.95 ,$228.78 ,$347.65 ,$368.10 ,$228.78 ,$306.75 ,$286.30 ,$302.66 ,$302.66 ,$409.00 ,$347.65 ,$228.78 ,$228.78 ,$286.71 ,$228.78 ,$170.14 , N/A ,$347.65 ,$491.88 ,$114.52 ,$368.10 ,$190.00 ,$228.78 ,$265.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$409.00 ,$265.85 ,$114.52 ,$571.95 ,$265.85 ,$228.78 ,$114.52 ,$206.95 ,$228.78 ,$235.18 ,$228.78 ,$206.91 ,$228.78 ,$409.00 ,$335.38 ,$571.95 ,$228.78 ,$347.65 ,$368.10 ,$228.78 ,$306.75 ,$286.30 ,$302.66 ,$302.66 ,$409.00 ,$347.65 ,$228.78 ,$228.78 ,$286.71 ,$228.78 ,$170.14 , N/A ,$347.65 ,$491.88 ,$114.52 ,$368.10 ,$190.00 ,$228.78 ,$265.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$305.00 ,$198.25 ,$85.40 ,$305.00 ,$198.25 ,$111.71 ,$85.40 ,$154.33 ,$111.71 ,$175.38 ,$111.71 ,$154.30 ,$111.71 ,$212.25 ,$250.10 ,$279.28 ,$111.71 ,$259.25 ,$274.50 ,$111.71 ,$228.75 ,$213.50 ,$225.70 ,$225.70 ,$279.28 ,$259.25 ,$111.71 ,$111.71 ,$213.81 ,$111.71 ,$126.88 , N/A ,$259.25 ,$240.18 ,$85.40 ,$274.50 ,$190.00 ,$111.71 ,$198.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$305.00 ,$198.25 ,$85.40 ,$305.00 ,$198.25 ,$111.71 ,$85.40 ,$154.33 ,$111.71 ,$175.38 ,$111.71 ,$154.30 ,$111.71 ,$212.25 ,$250.10 ,$279.28 ,$111.71 ,$259.25 ,$274.50 ,$111.71 ,$228.75 ,$213.50 ,$225.70 ,$225.70 ,$279.28 ,$259.25 ,$111.71 ,$111.71 ,$213.81 ,$111.71 ,$126.88 , N/A ,$259.25 ,$240.18 ,$85.40 ,$274.50 ,$190.00 ,$111.71 ,$198.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$305.00 ,$198.25 ,$85.40 ,$305.00 ,$198.25 ,$111.71 ,$85.40 ,$154.33 ,$111.71 ,$175.38 ,$111.71 ,$154.30 ,$111.71 ,$212.25 ,$250.10 ,$279.28 ,$111.71 ,$259.25 ,$274.50 ,$111.71 ,$228.75 ,$213.50 ,$225.70 ,$225.70 ,$279.28 ,$259.25 ,$111.71 ,$111.71 ,$213.81 ,$111.71 ,$126.88 , N/A ,$259.25 ,$240.18 ,$85.40 ,$274.50 ,$190.00 ,$111.71 ,$198.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$492.00 ,$319.80 ,$137.76 ,$851.90 ,$319.80 ,$340.76 ,$137.76 ,$248.95 ,$340.76 ,$282.90 ,$340.76 ,$248.90 ,$340.76 ,$492.00 ,$403.44 ,$851.90 ,$340.76 ,$418.20 ,$442.80 ,$340.76 ,$369.00 ,$344.40 ,$364.08 ,$364.08 ,$492.00 ,$418.20 ,$340.76 ,$340.76 ,$344.89 ,$340.76 ,$204.67 , N/A ,$418.20 ,$732.63 ,$137.76 ,$442.80 ,$492.00 ,$340.76 ,$319.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$492.00 ,$319.80 ,$137.76 ,"$1,533.75 ",$319.80 ,$613.50 ,$137.76 ,$248.95 ,$613.50 ,$282.90 ,$492.00 ,$248.90 ,$492.00 ,$492.00 ,$403.44 ,"$1,533.75 ",$613.50 ,$418.20 ,$442.80 ,$613.50 ,$369.00 ,$344.40 ,$364.08 ,$364.08 ,$492.00 ,$418.20 ,$613.50 ,$613.50 ,$344.89 ,$613.50 ,$204.67 , N/A ,$418.20 ,"$1,319.02 ",$137.76 ,$442.80 ,$492.00 ,$613.50 ,$319.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$928.00 ,$603.20 ,$259.84 ,$928.00 ,$603.20 ,$340.76 ,$259.84 ,$469.57 ,$340.76 ,$533.60 ,$340.76 ,$469.48 ,$340.76 ,$647.44 ,$760.96 ,$851.90 ,$340.76 ,$788.80 ,$835.20 ,$340.76 ,$696.00 ,$649.60 ,$686.72 ,$686.72 ,$851.90 ,$788.80 ,$340.76 ,$340.76 ,$650.53 ,$340.76 ,$386.05 , N/A ,$788.80 ,$732.63 ,$259.84 ,$835.20 ,$525.00 ,$340.76 ,$603.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$299.00 ,$194.35 ,$83.72 ,$442.60 ,$194.35 ,$177.04 ,$83.72 ,$151.29 ,$177.04 ,$171.93 ,$177.04 ,$151.26 ,$177.04 ,$299.00 ,$245.18 ,$442.60 ,$177.04 ,$254.15 ,$269.10 ,$177.04 ,$224.25 ,$209.30 ,$221.26 ,$221.26 ,$299.00 ,$254.15 ,$177.04 ,$177.04 ,$209.60 ,$177.04 ,$124.38 , N/A ,$254.15 ,$380.64 ,$83.72 ,$269.10 ,$299.00 ,$177.04 ,$194.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$111.17 ,$86.80 ,$156.86 ,$111.17 ,$178.25 ,$111.17 ,$156.83 ,$111.17 ,$211.22 ,$254.20 ,$277.92 ,$111.17 ,$263.50 ,$279.00 ,$111.17 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$277.92 ,$263.50 ,$111.17 ,$111.17 ,$217.31 ,$111.17 ,$128.96 , N/A ,$263.50 ,$239.01 ,$86.80 ,$279.00 ,$310.00 ,$111.17 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000012,11760,HC REPAIR NAIL BED,450,1 ,$647.00 ,$420.55 ,$181.16 ,"$1,290.85 ",$420.55 ,$516.34 ,$181.16 ,$327.38 ,$516.34 ,$372.03 ,$516.34 ,$327.32 ,$516.34 ,$647.00 ,$530.54 ,"$1,290.85 ",$516.34 ,$549.95 ,$582.30 ,$516.34 ,$485.25 ,$452.90 ,$478.78 ,$478.78 ,$647.00 ,$549.95 ,$516.34 ,$516.34 ,$453.55 ,$516.34 ,$269.15 , N/A ,$549.95 ,"$1,110.13 ",$181.16 ,$582.30 ,$525.00 ,$516.34 ,$420.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$324.00 ,$210.60 ,$90.72 ,$442.60 ,$210.60 ,$177.04 ,$90.72 ,$163.94 ,$177.04 ,$186.30 ,$177.04 ,$163.91 ,$177.04 ,$324.00 ,$265.68 ,$442.60 ,$177.04 ,$275.40 ,$291.60 ,$177.04 ,$243.00 ,$226.80 ,$239.76 ,$239.76 ,$324.00 ,$275.40 ,$177.04 ,$177.04 ,$227.12 ,$177.04 ,$134.78 , N/A ,$275.40 ,$380.64 ,$90.72 ,$291.60 ,$324.00 ,$177.04 ,$210.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$356.00 ,$231.40 ,$99.68 ,$442.60 ,$231.40 ,$177.04 ,$99.68 ,$180.14 ,$177.04 ,$204.70 ,$177.04 ,$180.10 ,$177.04 ,$336.38 ,$291.92 ,$442.60 ,$177.04 ,$302.60 ,$320.40 ,$177.04 ,$267.00 ,$249.20 ,$263.44 ,$263.44 ,$356.00 ,$302.60 ,$177.04 ,$177.04 ,$249.56 ,$177.04 ,$148.10 , N/A ,$302.60 ,$380.64 ,$99.68 ,$320.40 ,$356.00 ,$177.04 ,$231.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$391.00 ,$254.15 ,$109.48 ,$442.60 ,$254.15 ,$177.04 ,$109.48 ,$197.85 ,$177.04 ,$224.83 ,$177.04 ,$197.81 ,$177.04 ,$336.38 ,$320.62 ,$442.60 ,$177.04 ,$332.35 ,$351.90 ,$177.04 ,$293.25 ,$273.70 ,$289.34 ,$289.34 ,$391.00 ,$332.35 ,$177.04 ,$177.04 ,$274.09 ,$177.04 ,$162.66 , N/A ,$332.35 ,$380.64 ,$109.48 ,$351.90 ,$391.00 ,$177.04 ,$254.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$430.00 ,$279.50 ,$120.40 ,$851.90 ,$279.50 ,$340.76 ,$120.40 ,$217.58 ,$340.76 ,$247.25 ,$340.76 ,$217.54 ,$340.76 ,$430.00 ,$352.60 ,$851.90 ,$340.76 ,$365.50 ,$387.00 ,$340.76 ,$322.50 ,$301.00 ,$318.20 ,$318.20 ,$430.00 ,$365.50 ,$340.76 ,$340.76 ,$301.43 ,$340.76 ,$178.88 , N/A ,$365.50 ,$732.63 ,$120.40 ,$387.00 ,$430.00 ,$340.76 ,$279.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$488.00 ,$317.20 ,$136.64 ,$851.90 ,$317.20 ,$340.76 ,$136.64 ,$246.93 ,$340.76 ,$280.60 ,$340.76 ,$246.88 ,$340.76 ,$488.00 ,$400.16 ,$851.90 ,$340.76 ,$414.80 ,$439.20 ,$340.76 ,$366.00 ,$341.60 ,$361.12 ,$361.12 ,$488.00 ,$414.80 ,$340.76 ,$340.76 ,$342.09 ,$340.76 ,$203.01 , N/A ,$414.80 ,$732.63 ,$136.64 ,$439.20 ,$488.00 ,$340.76 ,$317.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$351.00 ,$228.15 ,$98.28 ,$442.60 ,$228.15 ,$177.04 ,$98.28 ,$177.61 ,$177.04 ,$201.83 ,$177.04 ,$177.57 ,$177.04 ,$336.38 ,$287.82 ,$442.60 ,$177.04 ,$298.35 ,$315.90 ,$177.04 ,$263.25 ,$245.70 ,$259.74 ,$259.74 ,$351.00 ,$298.35 ,$177.04 ,$177.04 ,$246.05 ,$177.04 ,$146.02 , N/A ,$298.35 ,$380.64 ,$98.28 ,$315.90 ,$351.00 ,$177.04 ,$228.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$385.00 ,$250.25 ,$107.80 ,$442.60 ,$250.25 ,$177.04 ,$107.80 ,$194.81 ,$177.04 ,$221.38 ,$177.04 ,$194.77 ,$177.04 ,$336.38 ,$315.70 ,$442.60 ,$177.04 ,$327.25 ,$346.50 ,$177.04 ,$288.75 ,$269.50 ,$284.90 ,$284.90 ,$385.00 ,$327.25 ,$177.04 ,$177.04 ,$269.89 ,$177.04 ,$160.16 , N/A ,$327.25 ,$380.64 ,$107.80 ,$346.50 ,$385.00 ,$177.04 ,$250.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$422.00 ,$274.30 ,$118.16 ,$442.60 ,$274.30 ,$177.04 ,$118.16 ,$213.53 ,$177.04 ,$242.65 ,$177.04 ,$213.49 ,$177.04 ,$336.38 ,$346.04 ,$442.60 ,$177.04 ,$358.70 ,$379.80 ,$177.04 ,$316.50 ,$295.40 ,$312.28 ,$312.28 ,$422.00 ,$358.70 ,$177.04 ,$177.04 ,$295.82 ,$177.04 ,$175.55 , N/A ,$358.70 ,$380.64 ,$118.16 ,$379.80 ,$422.00 ,$177.04 ,$274.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$459.00 ,$298.35 ,$128.52 ,$851.90 ,$298.35 ,$340.76 ,$128.52 ,$232.25 ,$340.76 ,$263.93 ,$340.76 ,$232.21 ,$340.76 ,$459.00 ,$376.38 ,$851.90 ,$340.76 ,$390.15 ,$413.10 ,$340.76 ,$344.25 ,$321.30 ,$339.66 ,$339.66 ,$459.00 ,$390.15 ,$340.76 ,$340.76 ,$321.76 ,$340.76 ,$190.94 , N/A ,$390.15 ,$732.63 ,$128.52 ,$413.10 ,$459.00 ,$340.76 ,$298.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,498.00 ",$973.70 ,$419.44 ,"$1,498.00 ",$973.70 ,$516.34 ,$419.44 ,$757.99 ,$516.34 ,$861.35 ,$516.34 ,$757.84 ,$516.34 ,$981.05 ,"$1,228.36 ","$1,290.85 ",$516.34 ,"$1,273.30 ","$1,348.20 ",$516.34 ,"$1,123.50 ","$1,048.60 ","$1,108.52 ","$1,108.52 ","$1,290.85 ","$1,273.30 ",$516.34 ,$516.34 ,"$1,050.10 ",$516.34 ,$623.17 , N/A ,"$1,273.30 ","$1,110.13 ",$419.44 ,"$1,348.20 ",$525.00 ,$516.34 ,$973.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$595.00 ,$386.75 ,$166.60 ,$851.90 ,$386.75 ,$340.76 ,$166.60 ,$301.07 ,$340.76 ,$342.13 ,$340.76 ,$301.01 ,$340.76 ,$595.00 ,$487.90 ,$851.90 ,$340.76 ,$505.75 ,$535.50 ,$340.76 ,$446.25 ,$416.50 ,$440.30 ,$440.30 ,$595.00 ,$505.75 ,$340.76 ,$340.76 ,$417.10 ,$340.76 ,$247.52 , N/A ,$505.75 ,$732.63 ,$166.60 ,$535.50 ,$525.00 ,$340.76 ,$386.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$542.00 ,$352.30 ,$151.76 ,$851.90 ,$352.30 ,$340.76 ,$151.76 ,$274.25 ,$340.76 ,$311.65 ,$340.76 ,$274.20 ,$340.76 ,$542.00 ,$444.44 ,$851.90 ,$340.76 ,$460.70 ,$487.80 ,$340.76 ,$406.50 ,$379.40 ,$401.08 ,$401.08 ,$542.00 ,$460.70 ,$340.76 ,$340.76 ,$379.94 ,$340.76 ,$225.47 , N/A ,$460.70 ,$732.63 ,$151.76 ,$487.80 ,$525.00 ,$340.76 ,$352.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$473.00 ,$307.45 ,$132.44 ,$851.90 ,$307.45 ,$340.76 ,$132.44 ,$239.34 ,$340.76 ,$271.98 ,$340.76 ,$239.29 ,$340.76 ,$473.00 ,$387.86 ,$851.90 ,$340.76 ,$402.05 ,$425.70 ,$340.76 ,$354.75 ,$331.10 ,$350.02 ,$350.02 ,$473.00 ,$402.05 ,$340.76 ,$340.76 ,$331.57 ,$340.76 ,$196.77 , N/A ,$402.05 ,$732.63 ,$132.44 ,$425.70 ,$473.00 ,$340.76 ,$307.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$299.00 ,$194.35 ,$83.72 ,$442.60 ,$194.35 ,$177.04 ,$83.72 ,$151.29 ,$177.04 ,$171.93 ,$177.04 ,$151.26 ,$177.04 ,$299.00 ,$245.18 ,$442.60 ,$177.04 ,$254.15 ,$269.10 ,$177.04 ,$224.25 ,$209.30 ,$221.26 ,$221.26 ,$299.00 ,$254.15 ,$177.04 ,$177.04 ,$209.60 ,$177.04 ,$124.38 , N/A ,$254.15 ,$380.64 ,$83.72 ,$269.10 ,$299.00 ,$177.04 ,$194.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$521.00 ,$338.65 ,$145.88 ,$521.00 ,$338.65 ,$177.04 ,$145.88 ,$263.63 ,$177.04 ,$299.58 ,$177.04 ,$263.57 ,$177.04 ,$336.38 ,$427.22 ,$442.60 ,$177.04 ,$442.85 ,$468.90 ,$177.04 ,$390.75 ,$364.70 ,$385.54 ,$385.54 ,$442.60 ,$442.85 ,$177.04 ,$177.04 ,$365.22 ,$177.04 ,$216.74 , N/A ,$442.85 ,$380.64 ,$145.88 ,$468.90 ,$521.00 ,$177.04 ,$338.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$409.00 ,$265.85 ,$114.52 ,$643.94 ,$265.85 ,$257.58 ,$114.52 ,$206.95 ,$257.58 ,$235.18 ,$257.58 ,$206.91 ,$257.58 ,$409.00 ,$335.38 ,$643.94 ,$257.58 ,$347.65 ,$368.10 ,$257.58 ,$306.75 ,$286.30 ,$302.66 ,$302.66 ,$409.00 ,$347.65 ,$257.58 ,$257.58 ,$286.71 ,$257.58 ,$170.14 , N/A ,$347.65 ,$553.79 ,$114.52 ,$368.10 ,$409.00 ,$257.58 ,$265.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$887.00 ,$576.55 ,$248.36 ,$887.00 ,$576.55 ,$257.58 ,$248.36 ,$448.82 ,$257.58 ,$510.03 ,$257.58 ,$448.73 ,$257.58 ,$489.39 ,$727.34 ,$643.94 ,$257.58 ,$753.95 ,$798.30 ,$257.58 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$643.94 ,$753.95 ,$257.58 ,$257.58 ,$621.79 ,$257.58 ,$368.99 , N/A ,$753.95 ,$553.79 ,$248.36 ,$798.30 ,$525.00 ,$257.58 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$887.00 ,$576.55 ,$248.36 ,$887.00 ,$576.55 ,$257.58 ,$248.36 ,$448.82 ,$257.58 ,$510.03 ,$257.58 ,$448.73 ,$257.58 ,$489.39 ,$727.34 ,$643.94 ,$257.58 ,$753.95 ,$798.30 ,$257.58 ,$665.25 ,$620.90 ,$656.38 ,$656.38 ,$643.94 ,$753.95 ,$257.58 ,$257.58 ,$621.79 ,$257.58 ,$368.99 , N/A ,$753.95 ,$553.79 ,$248.36 ,$798.30 ,$525.00 ,$257.58 ,$576.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$587.00 ,$381.55 ,$164.36 ,$587.00 ,$381.55 ,$203.20 ,$164.36 ,$297.02 ,$203.20 ,$337.53 ,$203.20 ,$296.96 ,$203.20 ,$386.08 ,$481.34 ,$508.00 ,$203.20 ,$498.95 ,$528.30 ,$203.20 ,$440.25 ,$410.90 ,$434.38 ,$434.38 ,$508.00 ,$498.95 ,$203.20 ,$203.20 ,$411.49 ,$203.20 ,$244.19 , N/A ,$498.95 ,$436.88 ,$164.36 ,$528.30 ,$525.00 ,$203.20 ,$381.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,"$3,965.00 ","$2,577.25 ",$525.00 ,"$3,965.00 ","$2,577.25 ","$1,373.18 ","$1,110.20 ","$2,006.29 ","$1,373.18 ","$2,279.88 ","$1,373.18 ","$2,005.89 ","$1,373.18 ","$2,609.04 ","$3,251.30 ","$3,432.94 ","$1,373.18 ","$3,370.25 ","$3,568.50 ","$1,373.18 ","$2,973.75 ","$2,775.50 ","$2,934.10 ","$2,934.10 ","$3,432.94 ","$3,370.25 ","$1,373.18 ","$1,373.18 ","$2,779.47 ","$1,373.18 ","$1,649.44 ", N/A ,"$3,370.25 ","$2,952.33 ","$1,110.20 ","$3,568.50 ",$525.00 ,"$1,373.18 ","$2,577.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$514.00 ,$334.10 ,$143.92 ,$514.00 ,$334.10 ,$203.20 ,$143.92 ,$260.08 ,$203.20 ,$295.55 ,$203.20 ,$260.03 ,$203.20 ,$386.08 ,$421.48 ,$508.00 ,$203.20 ,$436.90 ,$462.60 ,$203.20 ,$385.50 ,$359.80 ,$380.36 ,$380.36 ,$508.00 ,$436.90 ,$203.20 ,$203.20 ,$360.31 ,$203.20 ,$213.82 , N/A ,$436.90 ,$436.88 ,$143.92 ,$462.60 ,$514.00 ,$203.20 ,$334.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$587.00 ,$381.55 ,$164.36 ,$587.00 ,$381.55 ,$203.20 ,$164.36 ,$297.02 ,$203.20 ,$337.53 ,$203.20 ,$296.96 ,$203.20 ,$386.08 ,$481.34 ,$508.00 ,$203.20 ,$498.95 ,$528.30 ,$203.20 ,$440.25 ,$410.90 ,$434.38 ,$434.38 ,$508.00 ,$498.95 ,$203.20 ,$203.20 ,$411.49 ,$203.20 ,$244.19 , N/A ,$498.95 ,$436.88 ,$164.36 ,$528.30 ,$525.00 ,$203.20 ,$381.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000097,28190,HC REM FB FOOT SUBQ,450,1 ,"$2,853.00 ","$1,854.45 ",$525.00 ,"$2,853.00 ","$1,854.45 ",$613.50 ,$798.84 ,"$1,443.62 ",$613.50 ,"$1,640.48 ",$613.50 ,"$1,443.33 ",$613.50 ,"$1,165.65 ","$2,339.46 ","$1,533.75 ",$613.50 ,"$2,425.05 ","$2,567.70 ",$613.50 ,"$2,139.75 ","$1,997.10 ","$2,111.22 ","$2,111.22 ","$1,533.75 ","$2,425.05 ",$613.50 ,$613.50 ,"$1,999.95 ",$613.50 ,"$1,186.85 ", N/A ,"$2,425.05 ","$1,319.02 ",$798.84 ,"$2,567.70 ",$525.00 ,$613.50 ,"$1,854.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000098,29065,HC APPL CAST ARM LONG,450,1 ,$292.00 ,$189.80 ,$81.76 ,$594.59 ,$189.80 ,$237.84 ,$81.76 ,$147.75 ,$237.84 ,$167.90 ,$237.84 ,$147.72 ,$237.84 ,$292.00 ,$239.44 ,$594.59 ,$237.84 ,$248.20 ,$262.80 ,$237.84 ,$219.00 ,$204.40 ,$216.08 ,$216.08 ,$292.00 ,$248.20 ,$237.84 ,$237.84 ,$204.69 ,$237.84 ,$121.47 , N/A ,$248.20 ,$511.35 ,$81.76 ,$262.80 ,$292.00 ,$237.84 ,$189.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$292.00 ,$189.80 ,$81.76 ,$594.59 ,$189.80 ,$237.84 ,$81.76 ,$147.75 ,$237.84 ,$167.90 ,$237.84 ,$147.72 ,$237.84 ,$292.00 ,$239.44 ,$594.59 ,$237.84 ,$248.20 ,$262.80 ,$237.84 ,$219.00 ,$204.40 ,$216.08 ,$216.08 ,$292.00 ,$248.20 ,$237.84 ,$237.84 ,$204.69 ,$237.84 ,$121.47 , N/A ,$248.20 ,$511.35 ,$81.76 ,$262.80 ,$292.00 ,$237.84 ,$189.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$360.00 ,$234.00 ,$100.80 ,$360.00 ,$234.00 ,$139.29 ,$100.80 ,$182.16 ,$139.29 ,$207.00 ,$139.29 ,$182.12 ,$139.29 ,$264.64 ,$295.20 ,$348.22 ,$139.29 ,$306.00 ,$324.00 ,$139.29 ,$270.00 ,$252.00 ,$266.40 ,$266.40 ,$348.22 ,$306.00 ,$139.29 ,$139.29 ,$252.36 ,$139.29 ,$149.76 , N/A ,$306.00 ,$299.46 ,$100.80 ,$324.00 ,$360.00 ,$139.29 ,$234.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$360.00 ,$234.00 ,$100.80 ,$360.00 ,$234.00 ,$111.17 ,$100.80 ,$182.16 ,$111.17 ,$207.00 ,$111.17 ,$182.12 ,$111.17 ,$211.22 ,$295.20 ,$277.92 ,$111.17 ,$306.00 ,$324.00 ,$111.17 ,$270.00 ,$252.00 ,$266.40 ,$266.40 ,$277.92 ,$306.00 ,$111.17 ,$111.17 ,$252.36 ,$111.17 ,$149.76 , N/A ,$306.00 ,$239.01 ,$100.80 ,$324.00 ,$360.00 ,$111.17 ,$234.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$358.00 ,$232.70 ,$100.24 ,$358.00 ,$232.70 ,$111.17 ,$100.24 ,$181.15 ,$111.17 ,$205.85 ,$111.17 ,$181.11 ,$111.17 ,$211.22 ,$293.56 ,$277.92 ,$111.17 ,$304.30 ,$322.20 ,$111.17 ,$268.50 ,$250.60 ,$264.92 ,$264.92 ,$277.92 ,$304.30 ,$111.17 ,$111.17 ,$250.96 ,$111.17 ,$148.93 , N/A ,$304.30 ,$239.01 ,$100.24 ,$322.20 ,$358.00 ,$111.17 ,$232.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$358.00 ,$232.70 ,$100.24 ,$358.00 ,$232.70 ,$111.17 ,$100.24 ,$181.15 ,$111.17 ,$205.85 ,$111.17 ,$181.11 ,$111.17 ,$211.22 ,$293.56 ,$277.92 ,$111.17 ,$304.30 ,$322.20 ,$111.17 ,$268.50 ,$250.60 ,$264.92 ,$264.92 ,$277.92 ,$304.30 ,$111.17 ,$111.17 ,$250.96 ,$111.17 ,$148.93 , N/A ,$304.30 ,$239.01 ,$100.24 ,$322.20 ,$358.00 ,$111.17 ,$232.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$292.00 ,$189.80 ,$81.76 ,$594.59 ,$189.80 ,$237.84 ,$81.76 ,$147.75 ,$237.84 ,$167.90 ,$237.84 ,$147.72 ,$237.84 ,$292.00 ,$239.44 ,$594.59 ,$237.84 ,$248.20 ,$262.80 ,$237.84 ,$219.00 ,$204.40 ,$216.08 ,$216.08 ,$292.00 ,$248.20 ,$237.84 ,$237.84 ,$204.69 ,$237.84 ,$121.47 , N/A ,$248.20 ,$511.35 ,$81.76 ,$262.80 ,$292.00 ,$237.84 ,$189.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$358.00 ,$232.70 ,$100.24 ,$358.00 ,$232.70 ,$139.29 ,$100.24 ,$181.15 ,$139.29 ,$205.85 ,$139.29 ,$181.11 ,$139.29 ,$264.64 ,$293.56 ,$348.22 ,$139.29 ,$304.30 ,$322.20 ,$139.29 ,$268.50 ,$250.60 ,$264.92 ,$264.92 ,$348.22 ,$304.30 ,$139.29 ,$139.29 ,$250.96 ,$139.29 ,$148.93 , N/A ,$304.30 ,$299.46 ,$100.24 ,$322.20 ,$358.00 ,$139.29 ,$232.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$439.00 ,$285.35 ,$122.92 ,$439.00 ,$285.35 ,$139.29 ,$122.92 ,$222.13 ,$139.29 ,$252.43 ,$139.29 ,$222.09 ,$139.29 ,$264.64 ,$359.98 ,$348.22 ,$139.29 ,$373.15 ,$395.10 ,$139.29 ,$329.25 ,$307.30 ,$324.86 ,$324.86 ,$348.22 ,$373.15 ,$139.29 ,$139.29 ,$307.74 ,$139.29 ,$182.62 , N/A ,$373.15 ,$299.46 ,$122.92 ,$395.10 ,$439.00 ,$139.29 ,$285.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000110,30300,HC REM FB INTRANASAL,450,1 ,$226.00 ,$146.90 ,$63.28 ,$277.92 ,$146.90 ,$111.17 ,$63.28 ,$114.36 ,$111.17 ,$129.95 ,$111.17 ,$114.33 ,$111.17 ,$211.22 ,$185.32 ,$277.92 ,$111.17 ,$192.10 ,$203.40 ,$111.17 ,$169.50 ,$158.20 ,$167.24 ,$167.24 ,$226.00 ,$192.10 ,$111.17 ,$111.17 ,$158.43 ,$111.17 ,$94.02 , N/A ,$192.10 ,$239.01 ,$63.28 ,$203.40 ,$226.00 ,$111.17 ,$146.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$317.00 ,$206.05 ,$88.76 ,$317.00 ,$206.05 ,$111.17 ,$88.76 ,$160.40 ,$111.17 ,$182.28 ,$111.17 ,$160.37 ,$111.17 ,$211.22 ,$259.94 ,$277.92 ,$111.17 ,$269.45 ,$285.30 ,$111.17 ,$237.75 ,$221.90 ,$234.58 ,$234.58 ,$277.92 ,$269.45 ,$111.17 ,$111.17 ,$222.22 ,$111.17 ,$131.87 , N/A ,$269.45 ,$239.01 ,$88.76 ,$285.30 ,$317.00 ,$111.17 ,$206.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$391.00 ,$254.15 ,$109.48 ,$391.00 ,$254.15 ,$111.17 ,$109.48 ,$197.85 ,$111.17 ,$224.83 ,$111.17 ,$197.81 ,$111.17 ,$211.22 ,$320.62 ,$277.92 ,$111.17 ,$332.35 ,$351.90 ,$111.17 ,$293.25 ,$273.70 ,$289.34 ,$289.34 ,$277.92 ,$332.35 ,$111.17 ,$111.17 ,$274.09 ,$111.17 ,$162.66 , N/A ,$332.35 ,$239.01 ,$109.48 ,$351.90 ,$391.00 ,$111.17 ,$254.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000116,31720,HC ASP CATH NASOTRACHEAL,450,1 ,$137.00 ,$89.05 ,$38.36 ,$463.28 ,$89.05 ,$185.31 ,$38.36 ,$69.32 ,$185.31 ,$78.78 ,$137.00 ,$69.31 ,$137.00 ,$137.00 ,$112.34 ,$463.28 ,$185.31 ,$116.45 ,$123.30 ,$185.31 ,$102.75 ,$95.90 ,$101.38 ,$101.38 ,$137.00 ,$116.45 ,$185.31 ,$185.31 ,$96.04 ,$185.31 ,$56.99 , N/A ,$116.45 ,$398.42 ,$38.36 ,$123.30 ,$137.00 ,$185.31 ,$89.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000133,40650,HC RPR LIP FULL THICK VERMILN,450,1 ,"$1,288.00 ",$837.20 ,$360.64 ,"$1,288.00 ",$837.20 ,$445.88 ,$360.64 ,$651.73 ,$445.88 ,$740.60 ,$445.88 ,$651.60 ,$445.88 ,$847.17 ,"$1,056.16 ","$1,114.70 ",$445.88 ,"$1,094.80 ","$1,159.20 ",$445.88 ,$966.00 ,$901.60 ,$953.12 ,$953.12 ,"$1,114.70 ","$1,094.80 ",$445.88 ,$445.88 ,$902.89 ,$445.88 ,$535.81 , N/A ,"$1,094.80 ",$958.64 ,$360.64 ,"$1,159.20 ",$525.00 ,$445.88 ,$837.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$492.00 ,$319.80 ,$111.17 ,$492.00 ,$319.80 ,$111.17 ,$137.76 ,$248.95 ,$111.17 ,$282.90 ,$111.17 ,$248.90 ,$111.17 ,$211.22 ,$403.44 ,$277.92 ,$111.17 ,$418.20 ,$442.80 ,$111.17 ,$369.00 ,$344.40 ,$364.08 ,$364.08 ,$277.92 ,$418.20 ,$111.17 ,$111.17 ,$344.89 ,$111.17 ,$204.67 , N/A ,$418.20 ,$239.01 ,$137.76 ,$442.80 ,$492.00 ,$111.17 ,$319.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000143,43753,HC GASTRIC LAVAGE,450,1 ,$753.00 ,$489.45 ,$210.84 ,$753.00 ,$489.45 ,$260.92 ,$210.84 ,$381.02 ,$260.92 ,$432.98 ,$260.92 ,$380.94 ,$260.92 ,$495.74 ,$617.46 ,$652.29 ,$260.92 ,$640.05 ,$677.70 ,$260.92 ,$564.75 ,$527.10 ,$557.22 ,$557.22 ,$652.29 ,$640.05 ,$260.92 ,$260.92 ,$527.85 ,$260.92 ,$313.25 , N/A ,$640.05 ,$560.97 ,$210.84 ,$677.70 ,$525.00 ,$260.92 ,$489.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$286.00 ,$185.90 ,$80.08 ,$655.86 ,$185.90 ,$262.35 ,$80.08 ,$144.72 ,$262.35 ,$164.45 ,$262.35 ,$144.69 ,$262.35 ,$286.00 ,$234.52 ,$655.86 ,$262.35 ,$243.10 ,$257.40 ,$262.35 ,$214.50 ,$200.20 ,$211.64 ,$211.64 ,$286.00 ,$243.10 ,$262.35 ,$262.35 ,$200.49 ,$262.35 ,$118.98 , N/A ,$243.10 ,$564.04 ,$80.08 ,$257.40 ,$286.00 ,$262.35 ,$185.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$566.00 ,$367.90 ,$158.48 ,$695.13 ,$367.90 ,$278.05 ,$158.48 ,$286.40 ,$278.05 ,$325.45 ,$278.05 ,$286.34 ,$278.05 ,$528.30 ,$464.12 ,$695.13 ,$278.05 ,$481.10 ,$509.40 ,$278.05 ,$424.50 ,$396.20 ,$418.84 ,$418.84 ,$566.00 ,$481.10 ,$278.05 ,$278.05 ,$396.77 ,$278.05 ,$235.46 , N/A ,$481.10 ,$597.81 ,$158.48 ,$509.40 ,$525.00 ,$278.05 ,$367.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$517.00 ,$336.05 ,$144.76 ,$517.00 ,$336.05 ,$167.96 ,$144.76 ,$261.60 ,$167.96 ,$297.28 ,$167.96 ,$261.55 ,$167.96 ,$319.12 ,$423.94 ,$419.89 ,$167.96 ,$439.45 ,$465.30 ,$167.96 ,$387.75 ,$361.90 ,$382.58 ,$382.58 ,$419.89 ,$439.45 ,$167.96 ,$167.96 ,$362.42 ,$167.96 ,$215.07 , N/A ,$439.45 ,$361.11 ,$144.76 ,$465.30 ,$517.00 ,$167.96 ,$336.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$1,807.00 ","$1,174.55 ",$505.96 ,"$1,807.00 ","$1,174.55 ",$626.03 ,$505.96 ,$914.34 ,$626.03 ,"$1,039.03 ",$626.03 ,$914.16 ,$626.03 ,"$1,189.46 ","$1,481.74 ","$1,565.07 ",$626.03 ,"$1,535.95 ","$1,626.30 ",$626.03 ,"$1,355.25 ","$1,264.90 ","$1,337.18 ","$1,337.18 ","$1,565.07 ","$1,535.95 ",$626.03 ,$626.03 ,"$1,266.71 ",$626.03 ,$751.71 , N/A ,"$1,535.95 ","$1,345.96 ",$505.96 ,"$1,626.30 ",$525.00 ,$626.03 ,"$1,174.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$463.00 ,$300.95 ,$111.17 ,$463.00 ,$300.95 ,$111.17 ,$129.64 ,$234.28 ,$111.17 ,$266.23 ,$111.17 ,$234.23 ,$111.17 ,$211.22 ,$379.66 ,$277.92 ,$111.17 ,$393.55 ,$416.70 ,$111.17 ,$347.25 ,$324.10 ,$342.62 ,$342.62 ,$277.92 ,$393.55 ,$111.17 ,$111.17 ,$324.56 ,$111.17 ,$192.61 , N/A ,$393.55 ,$239.01 ,$129.64 ,$416.70 ,$463.00 ,$111.17 ,$300.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000181,69200,HC FB REMOVAL EAR,450,1 ,$226.00 ,$146.90 ,$63.28 ,$277.92 ,$146.90 ,$111.17 ,$63.28 ,$114.36 ,$111.17 ,$129.95 ,$111.17 ,$114.33 ,$111.17 ,$211.22 ,$185.32 ,$277.92 ,$111.17 ,$192.10 ,$203.40 ,$111.17 ,$169.50 ,$158.20 ,$167.24 ,$167.24 ,$226.00 ,$192.10 ,$111.17 ,$111.17 ,$158.43 ,$111.17 ,$94.02 , N/A ,$192.10 ,$239.01 ,$63.28 ,$203.40 ,$226.00 ,$111.17 ,$146.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$226.00 ,$146.90 ,$54.88 ,$226.00 ,$146.90 ,$54.88 ,$63.28 ,$114.36 ,$54.88 ,$129.95 ,$54.88 ,$114.33 ,$54.88 ,$104.27 ,$185.32 ,$137.20 ,$54.88 ,$192.10 ,$203.40 ,$54.88 ,$169.50 ,$158.20 ,$167.24 ,$167.24 ,$137.20 ,$192.10 ,$54.88 ,$54.88 ,$158.43 ,$54.88 ,$94.02 , N/A ,$192.10 ,$117.99 ,$63.28 ,$203.40 ,$226.00 ,$54.88 ,$146.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000188,99281,HC ER LEVEL 1,450,1 ,$244.00 ,$158.60 ,$68.32 ,$244.00 ,$158.60 ,$71.51 ,$68.32 ,$123.46 ,$71.51 ,$140.30 ,$71.51 ,$123.44 ,$71.51 ,$135.87 ,$200.08 ,$178.78 ,$71.51 ,$207.40 ,$219.60 ,$71.51 ,$183.00 ,$170.80 ,$180.56 ,$180.56 ,$178.78 ,$207.40 ,$71.51 ,$71.51 ,$171.04 ,$71.51 ,$101.50 , N/A ,$207.40 ,$153.75 ,$68.32 ,$219.60 ,$244.00 ,$71.51 ,$158.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000189,99282,HC ER LEVEL 2,450,1 ,$403.00 ,$261.95 ,$112.84 ,$403.00 ,$261.95 ,$129.50 ,$112.84 ,$203.92 ,$129.50 ,$231.73 ,$129.50 ,$203.88 ,$129.50 ,$246.05 ,$330.46 ,$323.74 ,$129.50 ,$342.55 ,$362.70 ,$129.50 ,$302.25 ,$282.10 ,$298.22 ,$298.22 ,$323.74 ,$342.55 ,$129.50 ,$129.50 ,$282.50 ,$129.50 ,$167.65 , N/A ,$342.55 ,$278.42 ,$112.84 ,$362.70 ,$403.00 ,$129.50 ,$261.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000190,99283,HC ER LEVEL 3,450,1 ,$641.00 ,$416.65 ,$179.48 ,$641.00 ,$416.65 ,$228.15 ,$179.48 ,$324.35 ,$228.15 ,$368.58 ,$228.15 ,$324.28 ,$228.15 ,$433.49 ,$525.62 ,$570.38 ,$228.15 ,$544.85 ,$576.90 ,$228.15 ,$480.75 ,$448.70 ,$474.34 ,$474.34 ,$570.38 ,$544.85 ,$228.15 ,$228.15 ,$449.34 ,$228.15 ,$266.66 , N/A ,$544.85 ,$490.53 ,$179.48 ,$576.90 ,$641.00 ,$228.15 ,$416.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000191,99284,HC ER LEVEL 4,450,1 ,"$1,023.00 ",$664.95 ,$286.44 ,"$1,023.00 ",$664.95 ,$358.64 ,$286.44 ,$517.64 ,$358.64 ,$588.23 ,$358.64 ,$517.54 ,$358.64 ,$681.41 ,$838.86 ,$896.59 ,$358.64 ,$869.55 ,$920.70 ,$358.64 ,$767.25 ,$716.10 ,$757.02 ,$757.02 ,$896.59 ,$869.55 ,$358.64 ,$358.64 ,$717.12 ,$358.64 ,$425.57 , N/A ,$869.55 ,$771.07 ,$286.44 ,$920.70 ,"$1,023.00 ",$358.64 ,$664.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000192,99285,HC ER LEVEL 5,450,1 ,"$1,506.00 ",$978.90 ,$421.68 ,"$1,506.00 ",$978.90 ,$514.78 ,$421.68 ,$762.04 ,$514.78 ,$865.95 ,$514.78 ,$761.89 ,$514.78 ,$978.07 ,"$1,234.92 ","$1,286.94 ",$514.78 ,"$1,280.10 ","$1,355.40 ",$514.78 ,"$1,129.50 ","$1,054.20 ","$1,114.44 ","$1,114.44 ","$1,286.94 ","$1,280.10 ",$514.78 ,$514.78 ,"$1,055.71 ",$514.78 ,$626.50 , N/A ,"$1,280.10 ","$1,106.77 ",$421.68 ,"$1,355.40 ","$1,506.00 ",$514.78 ,$978.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$2,158.00 ","$1,402.70 ",$604.24 ,"$2,158.00 ","$1,402.70 ",$734.36 ,$604.24 ,"$1,091.95 ",$734.36 ,"$1,240.85 ",$734.36 ,"$1,091.73 ",$734.36 ,"$1,395.28 ","$1,769.56 ","$1,835.89 ",$734.36 ,"$1,834.30 ","$1,942.20 ",$734.36 ,"$1,618.50 ","$1,510.60 ","$1,596.92 ","$1,596.92 ","$1,835.89 ","$1,834.30 ",$734.36 ,$734.36 ,"$1,512.76 ",$734.36 ,$897.73 , N/A ,"$1,834.30 ","$1,578.87 ",$604.24 ,"$1,942.20 ","$2,158.00 ",$734.36 ,"$1,402.70 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$693.00 ,$450.45 ,$194.04 ,$693.00 ,$450.45 , N/A ,$194.04 ,$350.66 , N/A ,$398.48 , N/A ,$350.59 , N/A , N/A ,$568.26 , N/A , N/A ,$589.05 ,$623.70 , N/A ,$519.75 ,$485.10 ,$512.82 ,$512.82 , N/A ,$589.05 , N/A , N/A ,$485.79 , N/A ,$288.29 , N/A ,$589.05 , N/A ,$194.04 ,$623.70 ,$525.00 , N/A ,$450.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,$576.00 ,$374.40 ,$161.28 ,$576.00 ,$374.40 ,$203.20 ,$161.28 ,$291.46 ,$203.20 ,$331.20 ,$203.20 ,$291.40 ,$203.20 ,$386.08 ,$472.32 ,$508.00 ,$203.20 ,$489.60 ,$518.40 ,$203.20 ,$432.00 ,$403.20 ,$426.24 ,$426.24 ,$508.00 ,$489.60 ,$203.20 ,$203.20 ,$403.78 ,$203.20 ,$239.62 , N/A ,$489.60 ,$436.88 ,$161.28 ,$518.40 ,$525.00 ,$203.20 ,$374.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000225,23540,HC CLOSED ACROM.W/O MANIP,450,1 ,$576.00 ,$374.40 ,$161.28 ,$576.00 ,$374.40 ,$203.20 ,$161.28 ,$291.46 ,$203.20 ,$331.20 ,$203.20 ,$291.40 ,$203.20 ,$386.08 ,$472.32 ,$508.00 ,$203.20 ,$489.60 ,$518.40 ,$203.20 ,$432.00 ,$403.20 ,$426.24 ,$426.24 ,$508.00 ,$489.60 ,$203.20 ,$203.20 ,$403.78 ,$203.20 ,$239.62 , N/A ,$489.60 ,$436.88 ,$161.28 ,$518.40 ,$525.00 ,$203.20 ,$374.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$587.00 ,$381.55 ,$164.36 ,$587.00 ,$381.55 ,$203.20 ,$164.36 ,$297.02 ,$203.20 ,$337.53 ,$203.20 ,$296.96 ,$203.20 ,$386.08 ,$481.34 ,$508.00 ,$203.20 ,$498.95 ,$528.30 ,$203.20 ,$440.25 ,$410.90 ,$434.38 ,$434.38 ,$508.00 ,$498.95 ,$203.20 ,$203.20 ,$411.49 ,$203.20 ,$244.19 , N/A ,$498.95 ,$436.88 ,$164.36 ,$528.30 ,$525.00 ,$203.20 ,$381.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000234,25560,HC RADIUS AND ULNA FX W/O MANIP,450,1 ,$587.00 ,$381.55 ,$164.36 ,$587.00 ,$381.55 ,$203.20 ,$164.36 ,$297.02 ,$203.20 ,$337.53 ,$203.20 ,$296.96 ,$203.20 ,$386.08 ,$481.34 ,$508.00 ,$203.20 ,$498.95 ,$528.30 ,$203.20 ,$440.25 ,$410.90 ,$434.38 ,$434.38 ,$508.00 ,$498.95 ,$203.20 ,$203.20 ,$411.49 ,$203.20 ,$244.19 , N/A ,$498.95 ,$436.88 ,$164.36 ,$528.30 ,$525.00 ,$203.20 ,$381.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000252,20520,HC MUSCLE FB REM W/ INC,450,1 ,"$1,518.00 ",$986.70 ,$425.04 ,"$3,467.89 ",$986.70 ,"$1,387.16 ",$425.04 ,$768.11 ,"$1,387.16 ",$872.85 ,"$1,387.16 ",$767.96 ,"$1,387.16 ","$1,518.00 ","$1,244.76 ","$3,467.89 ","$1,387.16 ","$1,290.30 ","$1,366.20 ","$1,387.16 ","$1,138.50 ","$1,062.60 ","$1,123.32 ","$1,123.32 ","$1,518.00 ","$1,290.30 ","$1,387.16 ","$1,387.16 ","$1,064.12 ","$1,387.16 ",$631.49 , N/A ,"$1,290.30 ","$2,982.38 ",$425.04 ,"$1,366.20 ",$525.00 ,"$1,387.16 ",$986.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$576.00 ,$374.40 ,$161.28 ,$576.00 ,$374.40 ,$203.20 ,$161.28 ,$291.46 ,$203.20 ,$331.20 ,$203.20 ,$291.40 ,$203.20 ,$386.08 ,$472.32 ,$508.00 ,$203.20 ,$489.60 ,$518.40 ,$203.20 ,$432.00 ,$403.20 ,$426.24 ,$426.24 ,$508.00 ,$489.60 ,$203.20 ,$203.20 ,$403.78 ,$203.20 ,$239.62 , N/A ,$489.60 ,$436.88 ,$161.28 ,$518.40 ,$525.00 ,$203.20 ,$374.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$755.00 ,$490.75 ,$203.20 ,$755.00 ,$490.75 ,$203.20 ,$211.40 ,$382.03 ,$203.20 ,$434.13 ,$203.20 ,$381.95 ,$203.20 ,$386.08 ,$619.10 ,$508.00 ,$203.20 ,$641.75 ,$679.50 ,$203.20 ,$566.25 ,$528.50 ,$558.70 ,$558.70 ,$508.00 ,$641.75 ,$203.20 ,$203.20 ,$529.26 ,$203.20 ,$314.08 , N/A ,$641.75 ,$436.88 ,$211.40 ,$679.50 ,$525.00 ,$203.20 ,$490.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000338,30906,HC CONTROL NASAL HEMORRHAGE SUBSQ,450,1 ,$403.00 ,$261.95 ,$112.84 ,$521.44 ,$261.95 ,$208.58 ,$112.84 ,$203.92 ,$208.58 ,$231.73 ,$208.58 ,$203.88 ,$208.58 ,$396.30 ,$330.46 ,$521.44 ,$208.58 ,$342.55 ,$362.70 ,$208.58 ,$302.25 ,$282.10 ,$298.22 ,$298.22 ,$403.00 ,$342.55 ,$208.58 ,$208.58 ,$282.50 ,$208.58 ,$167.65 , N/A ,$342.55 ,$448.44 ,$112.84 ,$362.70 ,$403.00 ,$208.58 ,$261.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000357,23650,HC TX DISL SHLDR W/MAN CLS-LT,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000358,23650,HC TX DISL SHLDR W/MAN CLS-RT,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000369,24640,HC DISLOCATION NURSEMAID ELBOW-LT,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000370,24640,HC DISLOCATION NURSEMAID ELBOW-RT,450,1 ,$559.00 ,$363.35 ,$156.52 ,$559.00 ,$363.35 ,$203.20 ,$156.52 ,$282.85 ,$203.20 ,$321.43 ,$203.20 ,$282.80 ,$203.20 ,$386.08 ,$458.38 ,$508.00 ,$203.20 ,$475.15 ,$503.10 ,$203.20 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$508.00 ,$475.15 ,$203.20 ,$203.20 ,$391.86 ,$203.20 ,$232.54 , N/A ,$475.15 ,$436.88 ,$156.52 ,$503.10 ,$525.00 ,$203.20 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000387,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT-LT,450,1 ,$514.00 ,$334.10 ,$143.92 ,$514.00 ,$334.10 ,$203.20 ,$143.92 ,$260.08 ,$203.20 ,$295.55 ,$203.20 ,$260.03 ,$203.20 ,$386.08 ,$421.48 ,$508.00 ,$203.20 ,$436.90 ,$462.60 ,$203.20 ,$385.50 ,$359.80 ,$380.36 ,$380.36 ,$508.00 ,$436.90 ,$203.20 ,$203.20 ,$360.31 ,$203.20 ,$213.82 , N/A ,$436.90 ,$436.88 ,$143.92 ,$462.60 ,$514.00 ,$203.20 ,$334.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000388,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT-RT,450,1 ,$514.00 ,$334.10 ,$143.92 ,$514.00 ,$334.10 ,$203.20 ,$143.92 ,$260.08 ,$203.20 ,$295.55 ,$203.20 ,$260.03 ,$203.20 ,$386.08 ,$421.48 ,$508.00 ,$203.20 ,$436.90 ,$462.60 ,$203.20 ,$385.50 ,$359.80 ,$380.36 ,$380.36 ,$508.00 ,$436.90 ,$203.20 ,$203.20 ,$360.31 ,$203.20 ,$213.82 , N/A ,$436.90 ,$436.88 ,$143.92 ,$462.60 ,$514.00 ,$203.20 ,$334.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000389,27550,HC CLSD TX KNEE DISLOC W/O ANESTH-LT,450,1 ,$755.00 ,$490.75 ,$203.20 ,$755.00 ,$490.75 ,$203.20 ,$211.40 ,$382.03 ,$203.20 ,$434.13 ,$203.20 ,$381.95 ,$203.20 ,$386.08 ,$619.10 ,$508.00 ,$203.20 ,$641.75 ,$679.50 ,$203.20 ,$566.25 ,$528.50 ,$558.70 ,$558.70 ,$508.00 ,$641.75 ,$203.20 ,$203.20 ,$529.26 ,$203.20 ,$314.08 , N/A ,$641.75 ,$436.88 ,$211.40 ,$679.50 ,$525.00 ,$203.20 ,$490.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000390,27550,HC CLSD TX KNEE DISLOC W/O ANESTH-RT,450,1 ,$755.00 ,$490.75 ,$203.20 ,$755.00 ,$490.75 ,$203.20 ,$211.40 ,$382.03 ,$203.20 ,$434.13 ,$203.20 ,$381.95 ,$203.20 ,$386.08 ,$619.10 ,$508.00 ,$203.20 ,$641.75 ,$679.50 ,$203.20 ,$566.25 ,$528.50 ,$558.70 ,$558.70 ,$508.00 ,$641.75 ,$203.20 ,$203.20 ,$529.26 ,$203.20 ,$314.08 , N/A ,$641.75 ,$436.88 ,$211.40 ,$679.50 ,$525.00 ,$203.20 ,$490.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000515,32551,HC TUBE THORACOSTOMY-BIL,450,1 ,"$2,811.00 ","$1,827.15 ",$525.00 ,"$7,055.60 ","$1,827.15 ","$2,822.24 ",$787.08 ,"$1,422.37 ","$2,822.24 ","$1,616.33 ","$2,811.00 ","$1,422.08 ","$2,811.00 ","$2,811.00 ","$2,305.02 ","$7,055.60 ","$2,822.24 ","$2,389.35 ","$2,529.90 ","$2,822.24 ","$2,108.25 ","$1,967.70 ","$2,080.14 ","$2,080.14 ","$2,811.00 ","$2,389.35 ","$2,822.24 ","$2,822.24 ","$1,970.51 ","$2,822.24 ","$1,169.38 ", N/A ,"$2,389.35 ","$6,067.81 ",$787.08 ,"$2,529.90 ",$525.00 ,"$2,822.24 ","$1,827.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000517,24640,HC DISLOCATION NURSEMAID ELBOW-BIL,450,1 ,$559.00 ,$363.35 ,$156.52 ,$762.00 ,$363.35 ,$304.80 ,$156.52 ,$282.85 ,$304.80 ,$321.43 ,$304.80 ,$282.80 ,$304.80 ,$559.00 ,$458.38 ,$762.00 ,$304.80 ,$475.15 ,$503.10 ,$304.80 ,$419.25 ,$391.30 ,$413.66 ,$413.66 ,$559.00 ,$475.15 ,$304.80 ,$304.80 ,$391.86 ,$304.80 ,$232.54 , N/A ,$475.15 ,$655.32 ,$156.52 ,$503.10 ,$525.00 ,$304.80 ,$363.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000561,28190,HC REMOVE FB FOOT SUBCUT,450,1 ,"$2,853.00 ","$1,854.45 ",$525.00 ,"$2,853.00 ","$1,854.45 ",$613.50 ,$798.84 ,"$1,443.62 ",$613.50 ,"$1,640.48 ",$613.50 ,"$1,443.33 ",$613.50 ,"$1,165.65 ","$2,339.46 ","$1,533.75 ",$613.50 ,"$2,425.05 ","$2,567.70 ",$613.50 ,"$2,139.75 ","$1,997.10 ","$2,111.22 ","$2,111.22 ","$1,533.75 ","$2,425.05 ",$613.50 ,$613.50 ,"$1,999.95 ",$613.50 ,"$1,186.85 ", N/A ,"$2,425.05 ","$1,319.02 ",$798.84 ,"$2,567.70 ",$525.00 ,$613.50 ,"$1,854.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45000562,28190,HC REMOVE FB FOOT SUBCUT,450,1 ,"$2,853.00 ","$1,854.45 ",$525.00 ,"$2,853.00 ","$1,854.45 ",$613.50 ,$798.84 ,"$1,443.62 ",$613.50 ,"$1,640.48 ",$613.50 ,"$1,443.33 ",$613.50 ,"$1,165.65 ","$2,339.46 ","$1,533.75 ",$613.50 ,"$2,425.05 ","$2,567.70 ",$613.50 ,"$2,139.75 ","$1,997.10 ","$2,111.22 ","$2,111.22 ","$1,533.75 ","$2,425.05 ",$613.50 ,$613.50 ,"$1,999.95 ",$613.50 ,"$1,186.85 ", N/A ,"$2,425.05 ","$1,319.02 ",$798.84 ,"$2,567.70 ",$525.00 ,$613.50 ,"$1,854.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$1,686.00 ","$1,095.90 ",$472.08 ,"$3,432.94 ","$1,095.90 ","$1,373.18 ",$472.08 ,$853.12 ,"$1,373.18 ",$969.45 ,"$1,373.18 ",$852.95 ,"$1,373.18 ","$1,686.00 ","$1,382.52 ","$3,432.94 ","$1,373.18 ","$1,433.10 ","$1,517.40 ","$1,373.18 ","$1,264.50 ","$1,180.20 ","$1,247.64 ","$1,247.64 ","$1,686.00 ","$1,433.10 ","$1,373.18 ","$1,373.18 ","$1,181.89 ","$1,373.18 ",$701.38 , N/A ,"$1,433.10 ","$2,952.33 ",$472.08 ,"$1,517.40 ",$525.00 ,"$1,373.18 ","$1,095.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$809.00 ,$525.85 ,$226.52 ,$809.00 ,$525.85 ,$262.35 ,$226.52 ,$409.35 ,$262.35 ,$465.18 ,$262.35 ,$409.27 ,$262.35 ,$498.46 ,$663.38 ,$655.86 ,$262.35 ,$687.65 ,$728.10 ,$262.35 ,$606.75 ,$566.30 ,$598.66 ,$598.66 ,$655.86 ,$687.65 ,$262.35 ,$262.35 ,$567.11 ,$262.35 ,$336.54 , N/A ,$687.65 ,$564.04 ,$226.52 ,$728.10 ,$525.00 ,$262.35 ,$525.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),45080001,10060,HC I AND D ABSC SMP,450,1 ,$539.00 ,$350.35 ,$150.92 ,$539.00 ,$350.35 ,$177.04 ,$150.92 ,$272.73 ,$177.04 ,$309.93 ,$177.04 ,$272.68 ,$177.04 ,$336.38 ,$441.98 ,$442.60 ,$177.04 ,$458.15 ,$485.10 ,$177.04 ,$404.25 ,$377.30 ,$398.86 ,$398.86 ,$442.60 ,$458.15 ,$177.04 ,$177.04 ,$377.84 ,$177.04 ,$224.22 , N/A ,$458.15 ,$380.64 ,$150.92 ,$485.10 ,$525.00 ,$177.04 ,$350.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$283.00 ,$183.95 ,$79.24 ,$344.11 ,$183.95 ,$137.65 ,$79.24 ,$143.20 ,$137.65 ,$162.73 ,$137.65 ,$143.17 ,$137.65 ,$261.53 ,$232.06 ,$344.11 ,$137.65 ,$240.55 ,$254.70 ,$137.65 ,$212.25 ,$198.10 ,$209.42 ,$209.42 ,$283.00 ,$240.55 ,$137.65 ,$137.65 ,$198.38 ,$137.65 ,$117.73 , N/A ,$240.55 ,$295.94 ,$79.24 ,$254.70 ,$245.00 ,$137.65 ,$183.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$472.00 ,$306.80 ,$132.16 ,$652.29 ,$306.80 ,$260.92 ,$132.16 ,$238.83 ,$260.92 ,$271.40 ,$260.92 ,$238.78 ,$260.92 ,$472.00 ,$387.04 ,$652.29 ,$260.92 ,$401.20 ,$424.80 ,$260.92 ,$354.00 ,$330.40 ,$349.28 ,$349.28 ,$472.00 ,$401.20 ,$260.92 ,$260.92 ,$330.87 ,$260.92 ,$196.35 , N/A ,$401.20 ,$560.97 ,$132.16 ,$424.80 ,$245.00 ,$260.92 ,$306.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000005,94060,HC SPIROMETRY/PFT PRE  AND  POST UPDRAFT,460,1 ,$874.00 ,$568.10 ,$244.72 ,$874.00 ,$568.10 ,$260.92 ,$244.72 ,$442.24 ,$260.92 ,$502.55 ,$260.92 ,$442.16 ,$260.92 ,$495.74 ,$716.68 ,$652.29 ,$260.92 ,$742.90 ,$786.60 ,$260.92 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$652.29 ,$742.90 ,$260.92 ,$260.92 ,$612.67 ,$260.92 ,$363.58 , N/A ,$742.90 ,$560.97 ,$244.72 ,$786.60 ,$245.00 ,$260.92 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000013,94726,HC PLETHYSMOGRAPHY,460,1 ,$437.00 ,$284.05 ,$122.36 ,$652.29 ,$284.05 ,$260.92 ,$122.36 ,$221.12 ,$260.92 ,$251.28 ,$260.92 ,$221.08 ,$260.92 ,$437.00 ,$358.34 ,$652.29 ,$260.92 ,$371.45 ,$393.30 ,$260.92 ,$327.75 ,$305.90 ,$323.38 ,$323.38 ,$437.00 ,$371.45 ,$260.92 ,$260.92 ,$306.34 ,$260.92 ,$181.79 , N/A ,$371.45 ,$560.97 ,$122.36 ,$393.30 ,$245.00 ,$260.92 ,$284.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$437.00 ,$284.05 ,$122.36 ,$437.00 ,$284.05 , N/A ,$122.36 ,$221.12 , N/A ,$251.28 , N/A ,$221.08 , N/A , N/A ,$358.34 , N/A , N/A ,$371.45 ,$393.30 , N/A ,$327.75 ,$305.90 ,$323.38 ,$323.38 , N/A ,$371.45 , N/A , N/A ,$306.34 , N/A ,$181.79 , N/A ,$371.45 , N/A ,$122.36 ,$393.30 ,$245.00 , N/A ,$284.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000021,94760,HC PULSE OX SINGLE,460,1 ,$55.00 ,$35.75 ,$15.40 ,$55.00 ,$35.75 , N/A ,$15.40 ,$27.83 , N/A ,$31.63 , N/A ,$27.82 , N/A , N/A ,$45.10 , N/A , N/A ,$46.75 ,$49.50 , N/A ,$41.25 ,$38.50 ,$40.70 ,$40.70 , N/A ,$46.75 , N/A , N/A ,$38.56 , N/A ,$22.88 , N/A ,$46.75 , N/A ,$15.40 ,$49.50 ,$55.00 , N/A ,$35.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$158.00 ,$102.70 ,$44.24 ,$158.00 ,$102.70 ,$54.88 ,$44.24 ,$79.95 ,$54.88 ,$90.85 ,$54.88 ,$79.93 ,$54.88 ,$104.27 ,$129.56 ,$137.20 ,$54.88 ,$134.30 ,$142.20 ,$54.88 ,$118.50 ,$110.60 ,$116.92 ,$116.92 ,$137.20 ,$134.30 ,$54.88 ,$54.88 ,$110.76 ,$54.88 ,$65.73 , N/A ,$134.30 ,$117.99 ,$44.24 ,$142.20 ,$95.00 ,$54.88 ,$102.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),46000023,94761,HC PULSE OX MULTI DETERMIN,360,1 ,$129.00 ,$83.85 ,$36.12 ,$129.00 ,$83.85 , N/A ,$36.12 ,$65.27 , N/A ,$74.18 , N/A ,$65.26 , N/A , N/A ,$105.78 , N/A , N/A ,$109.65 ,$116.10 , N/A ,$96.75 ,$90.30 ,$95.46 ,$95.46 , N/A ,$109.65 , N/A , N/A ,$90.43 , N/A ,$53.66 , N/A ,$109.65 , N/A ,$36.12 ,$116.10 , N/A , N/A ,$83.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,686.00 ","$1,095.90 ",$472.08 ,"$1,686.00 ","$1,095.90 ",$553.83 ,$472.08 ,$853.12 ,$553.83 ,$969.45 ,$553.83 ,$852.95 ,$553.83 ,"$1,052.28 ","$1,382.52 ","$1,384.58 ",$553.83 ,"$1,433.10 ","$1,517.40 ",$553.83 ,"$1,264.50 ","$1,180.20 ","$1,247.64 ","$1,247.64 ","$1,384.58 ","$1,433.10 ",$553.83 ,$553.83 ,"$1,181.89 ",$553.83 ,$701.38 , N/A ,"$1,433.10 ","$1,190.74 ",$472.08 ,"$1,517.40 ","$1,550.00 ",$553.83 ,"$1,095.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$173.00 ,$112.45 ,$48.44 ,$173.00 ,$112.45 ,$54.88 ,$48.44 ,$87.54 ,$54.88 ,$99.48 ,$54.88 ,$87.52 ,$54.88 ,$104.27 ,$141.86 ,$137.20 ,$54.88 ,$147.05 ,$155.70 ,$54.88 ,$129.75 ,$121.10 ,$128.02 ,$128.02 ,$137.20 ,$147.05 ,$54.88 ,$54.88 ,$121.27 ,$54.88 ,$71.97 , N/A ,$147.05 ,$117.99 ,$48.44 ,$155.70 ,$173.00 ,$54.88 ,$112.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,028.00 ",$668.20 ,$260.92 ,"$1,028.00 ",$668.20 ,$260.92 ,$287.84 ,$520.17 ,$260.92 ,$591.10 ,$260.92 ,$520.07 ,$260.92 ,$495.74 ,$842.96 ,$652.29 ,$260.92 ,$873.80 ,$925.20 ,$260.92 ,$771.00 ,$719.60 ,$760.72 ,$760.72 ,$652.29 ,$873.80 ,$260.92 ,$260.92 ,$720.63 ,$260.92 ,$427.65 , N/A ,$873.80 ,$560.97 ,$287.84 ,$925.20 ,$950.00 ,$260.92 ,$668.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$2,565.00 ","$1,667.25 ",$400.00 ,"$2,565.00 ","$1,667.25 ",$476.37 ,$718.20 ,"$1,297.89 ",$476.37 ,"$1,474.88 ",$476.37 ,"$1,297.63 ",$476.37 ,$905.10 ,"$2,103.30 ","$1,190.92 ",$476.37 ,"$2,180.25 ","$2,308.50 ",$476.37 ,"$1,923.75 ","$1,795.50 ","$1,898.10 ","$1,898.10 ","$1,190.92 ","$2,180.25 ",$476.37 ,$476.37 ,"$1,798.07 ",$476.37 ,"$1,067.04 ", N/A ,"$2,180.25 ","$1,024.19 ",$718.20 ,"$2,308.50 ",$400.00 ,$476.37 ,"$1,667.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300001,93307,HC ECHOCARDIOGRAM 2D W/O DOP,483,1 ,$655.00 ,$425.75 ,$183.40 ,$655.00 ,$425.75 ,$226.85 ,$183.40 ,$331.43 ,$226.85 ,$376.63 ,$226.85 ,$331.36 ,$226.85 ,$431.02 ,$537.10 ,$567.13 ,$226.85 ,$556.75 ,$589.50 ,$226.85 ,$491.25 ,$458.50 ,$484.70 ,$484.70 ,$567.13 ,$556.75 ,$226.85 ,$226.85 ,$459.16 ,$226.85 ,$272.48 , N/A ,$556.75 ,$487.73 ,$183.40 ,$589.50 ,$400.00 ,$226.85 ,$425.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$466.00 ,$302.90 ,$130.48 ,$567.13 ,$302.90 ,$226.85 ,$130.48 ,$235.80 ,$226.85 ,$267.95 ,$226.85 ,$235.75 ,$226.85 ,$431.02 ,$382.12 ,$567.13 ,$226.85 ,$396.10 ,$419.40 ,$226.85 ,$349.50 ,$326.20 ,$344.84 ,$344.84 ,$466.00 ,$396.10 ,$226.85 ,$226.85 ,$326.67 ,$226.85 ,$193.86 , N/A ,$396.10 ,$487.73 ,$130.48 ,$419.40 ,$400.00 ,$226.85 ,$302.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300005,93320,HC ECHO DOPPLER,483,1 ,$965.00 ,$627.25 ,$270.20 ,$965.00 ,$627.25 , N/A ,$270.20 ,$488.29 , N/A ,$554.88 , N/A ,$488.19 , N/A , N/A ,$791.30 , N/A , N/A ,$820.25 ,$868.50 , N/A ,$723.75 ,$675.50 ,$714.10 ,$714.10 , N/A ,$820.25 , N/A , N/A ,$676.47 , N/A ,$401.44 , N/A ,$820.25 , N/A ,$270.20 ,$868.50 ,$400.00 , N/A ,$627.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$774.00 ,$503.10 ,$216.72 ,$774.00 ,$503.10 , N/A ,$216.72 ,$391.64 , N/A ,$445.05 , N/A ,$391.57 , N/A , N/A ,$634.68 , N/A , N/A ,$657.90 ,$696.60 , N/A ,$580.50 ,$541.80 ,$572.76 ,$572.76 , N/A ,$657.90 , N/A , N/A ,$542.57 , N/A ,$321.98 , N/A ,$657.90 , N/A ,$216.72 ,$696.60 ,$400.00 , N/A ,$503.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$1,780.00 ","$1,157.00 ",$400.00 ,"$1,780.00 ","$1,157.00 ",$476.37 ,$498.40 ,$900.68 ,$476.37 ,"$1,023.50 ",$476.37 ,$900.50 ,$476.37 ,$905.10 ,"$1,459.60 ","$1,190.92 ",$476.37 ,"$1,513.00 ","$1,602.00 ",$476.37 ,"$1,335.00 ","$1,246.00 ","$1,317.20 ","$1,317.20 ","$1,190.92 ","$1,513.00 ",$476.37 ,$476.37 ,"$1,247.78 ",$476.37 ,$740.48 , N/A ,"$1,513.00 ","$1,024.19 ",$498.40 ,"$1,602.00 ",$400.00 ,$476.37 ,"$1,157.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300008,93303,HC ECHO PEDS CONGENITAL,483,1 ,"$1,375.00 ",$893.75 ,$385.00 ,"$1,375.00 ",$893.75 ,$476.37 ,$385.00 ,$695.75 ,$476.37 ,$790.63 ,$476.37 ,$695.61 ,$476.37 ,$905.10 ,"$1,127.50 ","$1,190.92 ",$476.37 ,"$1,168.75 ","$1,237.50 ",$476.37 ,"$1,031.25 ",$962.50 ,"$1,017.50 ","$1,017.50 ","$1,190.92 ","$1,168.75 ",$476.37 ,$476.37 ,$963.88 ,$476.37 ,$572.00 , N/A ,"$1,168.75 ","$1,024.19 ",$385.00 ,"$1,237.50 ",$400.00 ,$476.37 ,$893.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300009,93304,HC ECHO PEDS CONGENITAL LMTD,483,1 ,"$1,375.00 ",$893.75 ,$385.00 ,"$1,375.00 ",$893.75 ,$476.37 ,$385.00 ,$695.75 ,$476.37 ,$790.63 ,$476.37 ,$695.61 ,$476.37 ,$905.10 ,"$1,127.50 ","$1,190.92 ",$476.37 ,"$1,168.75 ","$1,237.50 ",$476.37 ,"$1,031.25 ",$962.50 ,"$1,017.50 ","$1,017.50 ","$1,190.92 ","$1,168.75 ",$476.37 ,$476.37 ,$963.88 ,$476.37 ,$572.00 , N/A ,"$1,168.75 ","$1,024.19 ",$385.00 ,"$1,237.50 ",$400.00 ,$476.37 ,$893.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$593.00 ,$385.45 ,$166.04 ,$593.00 ,$385.45 , N/A ,$166.04 ,$300.06 , N/A ,$340.98 , N/A ,$300.00 , N/A , N/A ,$486.26 , N/A , N/A ,$504.05 ,$533.70 , N/A ,$444.75 ,$415.10 ,$438.82 ,$438.82 , N/A ,$504.05 , N/A , N/A ,$415.69 , N/A ,$246.69 , N/A ,$504.05 , N/A ,$166.04 ,$533.70 ,$400.00 , N/A ,$385.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300011,93351,HC ECHO 2D STRESS CONT MONITORING,483,1 ,"$1,375.00 ",$893.75 ,$385.00 ,"$1,375.00 ",$893.75 ,$476.37 ,$385.00 ,$695.75 ,$476.37 ,$790.63 ,$476.37 ,$695.61 ,$476.37 ,$905.10 ,"$1,127.50 ","$1,190.92 ",$476.37 ,"$1,168.75 ","$1,237.50 ",$476.37 ,"$1,031.25 ",$962.50 ,"$1,017.50 ","$1,017.50 ","$1,190.92 ","$1,168.75 ",$476.37 ,$476.37 ,$963.88 ,$476.37 ,$572.00 , N/A ,"$1,168.75 ","$1,024.19 ",$385.00 ,"$1,237.50 ",$400.00 ,$476.37 ,$893.75 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,193.00 ",$775.45 ,$334.04 ,"$1,193.00 ",$775.45 ,$363.05 ,$334.04 ,$603.66 ,$363.05 ,$685.98 ,$363.05 ,$603.54 ,$363.05 ,$689.79 ,$978.26 ,$907.62 ,$363.05 ,"$1,014.05 ","$1,073.70 ",$363.05 ,$894.75 ,$835.10 ,$882.82 ,$882.82 ,$907.62 ,"$1,014.05 ",$363.05 ,$363.05 ,$836.29 ,$363.05 ,$496.29 , N/A ,"$1,014.05 ",$780.55 ,$334.04 ,"$1,073.70 ",$400.00 ,$363.05 ,$775.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$2,036.00 ","$1,323.40 ",$400.00 ,"$2,036.00 ","$1,323.40 ",$705.33 ,$570.08 ,"$1,030.22 ",$705.33 ,"$1,170.70 ",$705.33 ,"$1,030.01 ",$705.33 ,"$1,340.13 ","$1,669.52 ","$1,763.33 ",$705.33 ,"$1,730.60 ","$1,832.40 ",$705.33 ,"$1,527.00 ","$1,425.20 ","$1,506.64 ","$1,506.64 ","$1,763.33 ","$1,730.60 ",$705.33 ,$705.33 ,"$1,427.24 ",$705.33 ,$846.98 , N/A ,"$1,730.60 ","$1,516.46 ",$570.08 ,"$1,832.40 ",$400.00 ,$705.33 ,"$1,323.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$3,885.00 ","$2,525.25 ",$400.00 ,"$3,885.00 ","$2,525.25 ",$705.33 ,"$1,087.80 ","$1,965.81 ",$705.33 ,"$2,233.88 ",$705.33 ,"$1,965.42 ",$705.33 ,"$1,340.13 ","$3,185.70 ","$1,763.33 ",$705.33 ,"$3,302.25 ","$3,496.50 ",$705.33 ,"$2,913.75 ","$2,719.50 ","$2,874.90 ","$2,874.90 ","$1,763.33 ","$3,302.25 ",$705.33 ,$705.33 ,"$2,723.39 ",$705.33 ,"$1,616.16 ", N/A ,"$3,302.25 ","$1,516.46 ","$1,087.80 ","$3,496.50 ",$400.00 ,$705.33 ,"$2,525.25 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),48300020,C8930,HC ECHO TTE 2D REST/STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$2,036.00 ","$1,323.40 ",$400.00 ,"$2,036.00 ","$1,323.40 ",$705.33 ,$570.08 ,"$1,030.22 ",$705.33 ,"$1,170.70 ",$705.33 ,"$1,030.01 ",$705.33 ,"$1,340.13 ","$1,669.52 ","$1,763.33 ",$705.33 ,"$1,730.60 ","$1,832.40 ",$705.33 ,"$1,527.00 ","$1,425.20 ","$1,506.64 ","$1,506.64 ","$1,763.33 ","$1,730.60 ",$705.33 ,$705.33 ,"$1,427.24 ",$705.33 ,$846.98 , N/A ,"$1,730.60 ","$1,516.46 ",$570.08 ,"$1,832.40 ",$400.00 ,$705.33 ,"$1,323.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000002,95117,HC ALLERGY SHOTS 2 OR MORE,510,1 ,$190.00 ,$123.50 ,$39.45 ,$190.00 ,$123.50 ,$39.45 ,$53.20 ,$96.14 ,$39.45 ,$109.25 ,$39.45 ,$96.12 ,$39.45 ,$74.96 ,$155.80 ,$98.63 ,$39.45 ,$161.50 ,$171.00 ,$39.45 ,$142.50 ,$133.00 ,$140.60 ,$140.60 ,$98.63 ,$161.50 ,$39.45 ,$39.45 ,$133.19 ,$39.45 ,$79.04 , N/A ,$161.50 ,$84.82 ,$53.20 ,$171.00 ,$125.00 ,$39.45 ,$123.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$818.00 ,$531.70 ,$125.00 ,$818.00 ,$531.70 ,$314.35 ,$229.04 ,$413.91 ,$314.35 ,$470.35 ,$314.35 ,$413.83 ,$314.35 ,$597.26 ,$670.76 ,$785.87 ,$314.35 ,$695.30 ,$736.20 ,$314.35 ,$613.50 ,$572.60 ,$605.32 ,$605.32 ,$785.87 ,$695.30 ,$314.35 ,$314.35 ,$573.42 ,$314.35 ,$340.29 , N/A ,$695.30 ,$675.85 ,$229.04 ,$736.20 ,$125.00 ,$314.35 ,$531.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$132.00 ,$85.80 ,$36.96 ,$152.81 ,$85.80 ,$61.12 ,$36.96 ,$66.79 ,$61.12 ,$75.90 ,$61.12 ,$66.78 ,$61.12 ,$116.14 ,$108.24 ,$152.81 ,$61.12 ,$112.20 ,$118.80 ,$61.12 ,$99.00 ,$92.40 ,$97.68 ,$97.68 ,$132.00 ,$112.20 ,$61.12 ,$61.12 ,$92.53 ,$61.12 ,$54.91 , N/A ,$112.20 ,$131.42 ,$36.96 ,$118.80 ,$69.70 ,$61.12 ,$85.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$285.00 ,$185.25 ,$79.80 ,$504.21 ,$185.25 ,$201.68 ,$79.80 ,$144.21 ,$201.68 ,$163.88 ,$201.68 ,$144.18 ,$201.68 ,$285.00 ,$233.70 ,$504.21 ,$201.68 ,$242.25 ,$256.50 ,$201.68 ,$213.75 ,$199.50 ,$210.90 ,$210.90 ,$285.00 ,$242.25 ,$201.68 ,$201.68 ,$199.79 ,$201.68 ,$118.56 , N/A ,$242.25 ,$433.62 ,$79.80 ,$256.50 ,$150.48 ,$201.68 ,$185.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$172.00 ,$111.80 ,$39.45 ,$172.00 ,$111.80 ,$39.45 ,$48.16 ,$87.03 ,$39.45 ,$98.90 ,$39.45 ,$87.01 ,$39.45 ,$74.96 ,$141.04 ,$98.63 ,$39.45 ,$146.20 ,$154.80 ,$39.45 ,$129.00 ,$120.40 ,$127.28 ,$127.28 ,$98.63 ,$146.20 ,$39.45 ,$39.45 ,$120.57 ,$39.45 ,$71.55 , N/A ,$146.20 ,$84.82 ,$48.16 ,$154.80 ,$90.82 ,$39.45 ,$111.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$172.00 ,$111.80 ,$48.16 ,$172.00 ,$111.80 , N/A ,$48.16 ,$87.03 , N/A ,$98.90 , N/A ,$87.01 , N/A , N/A ,$141.04 , N/A , N/A ,$146.20 ,$154.80 , N/A ,$129.00 ,$120.40 ,$127.28 ,$127.28 , N/A ,$146.20 , N/A , N/A ,$120.57 , N/A ,$71.55 , N/A ,$146.20 , N/A ,$48.16 ,$154.80 ,$90.82 , N/A ,$111.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$161.00 ,$104.65 ,$45.08 ,$161.00 ,$104.65 ,$54.88 ,$45.08 ,$81.47 ,$54.88 ,$92.58 ,$54.88 ,$81.45 ,$54.88 ,$104.27 ,$132.02 ,$137.20 ,$54.88 ,$136.85 ,$144.90 ,$54.88 ,$120.75 ,$112.70 ,$119.14 ,$119.14 ,$137.20 ,$136.85 ,$54.88 ,$54.88 ,$112.86 ,$54.88 ,$66.98 , N/A ,$136.85 ,$117.99 ,$45.08 ,$144.90 ,$125.00 ,$54.88 ,$104.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$242.00 ,$157.30 ,$67.76 ,$242.00 ,$157.30 , N/A ,$67.76 ,$122.45 , N/A ,$139.15 , N/A ,$122.43 , N/A , N/A ,$198.44 , N/A , N/A ,$205.70 ,$217.80 , N/A ,$181.50 ,$169.40 ,$179.08 ,$179.08 , N/A ,$205.70 , N/A , N/A ,$169.64 , N/A ,$100.67 , N/A ,$205.70 , N/A ,$67.76 ,$217.80 ,$125.00 , N/A ,$157.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$209.00 ,$135.85 ,$58.52 ,$277.92 ,$135.85 ,$111.17 ,$58.52 ,$105.75 ,$111.17 ,$120.18 ,$111.17 ,$105.73 ,$111.17 ,$209.00 ,$171.38 ,$277.92 ,$111.17 ,$177.65 ,$188.10 ,$111.17 ,$156.75 ,$146.30 ,$154.66 ,$154.66 ,$209.00 ,$177.65 ,$111.17 ,$111.17 ,$146.51 ,$111.17 ,$86.94 , N/A ,$177.65 ,$239.01 ,$58.52 ,$188.10 ,$125.00 ,$111.17 ,$135.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000172,51702,HC CATH BLADDER SMP,510,1 ,$317.00 ,$206.05 ,$88.76 ,$317.00 ,$206.05 ,$111.17 ,$88.76 ,$160.40 ,$111.17 ,$182.28 ,$111.17 ,$160.37 ,$111.17 ,$211.22 ,$259.94 ,$277.92 ,$111.17 ,$269.45 ,$285.30 ,$111.17 ,$237.75 ,$221.90 ,$234.58 ,$234.58 ,$277.92 ,$269.45 ,$111.17 ,$111.17 ,$222.22 ,$111.17 ,$131.87 , N/A ,$269.45 ,$239.01 ,$88.76 ,$285.30 ,$125.00 ,$111.17 ,$206.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51000173,51703,HC CATH BLADDER CPLX,510,1 ,$401.00 ,$260.65 ,$112.28 ,$401.00 ,$260.65 ,$137.65 ,$112.28 ,$202.91 ,$137.65 ,$230.58 ,$137.65 ,$202.87 ,$137.65 ,$261.53 ,$328.82 ,$344.11 ,$137.65 ,$340.85 ,$360.90 ,$137.65 ,$300.75 ,$280.70 ,$296.74 ,$296.74 ,$344.11 ,$340.85 ,$137.65 ,$137.65 ,$281.10 ,$137.65 ,$166.82 , N/A ,$340.85 ,$295.94 ,$112.28 ,$360.90 ,$125.00 ,$137.65 ,$260.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51001012,95115,HC ALLERGY SHOTS ONE INJECTION,510,1 ,$121.00 ,$78.65 ,$33.88 ,$121.00 ,$78.65 ,$39.45 ,$33.88 ,$61.23 ,$39.45 ,$69.58 ,$39.45 ,$61.21 ,$39.45 ,$74.96 ,$99.22 ,$98.63 ,$39.45 ,$102.85 ,$108.90 ,$39.45 ,$90.75 ,$84.70 ,$89.54 ,$89.54 ,$98.63 ,$102.85 ,$39.45 ,$39.45 ,$84.82 ,$39.45 ,$50.34 , N/A ,$102.85 ,$84.82 ,$33.88 ,$108.90 ,$121.00 ,$39.45 ,$78.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),51070001,98960,HC EDUCATION SELF MGNT NON PHY HLTCARE PROF,510,1 ,$140.00 ,$91.00 ,$39.20 ,$140.00 ,$91.00 , N/A ,$39.20 ,$70.84 , N/A ,$80.50 , N/A ,$70.83 , N/A , N/A ,$114.80 , N/A , N/A ,$119.00 ,$126.00 , N/A ,$105.00 ,$98.00 ,$103.60 ,$103.60 , N/A ,$119.00 , N/A , N/A ,$98.14 , N/A ,$58.24 , N/A ,$119.00 , N/A ,$39.20 ,$126.00 ,$125.00 , N/A ,$91.00 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$1,324.40 ","$2,393.38 ",$363.05 ,"$2,719.75 ",$363.05 ,"$2,392.91 ",$363.05 ,$689.79 ,"$3,878.60 ",$907.62 ,$363.05 ,"$4,020.50 ","$4,257.00 ",$363.05 ,"$3,547.50 ","$3,311.00 ","$3,500.20 ","$3,500.20 ",$907.62 ,"$4,020.50 ",$363.05 ,$363.05 ,"$3,315.73 ",$363.05 ,"$1,967.68 ", N/A ,"$4,020.50 ",$780.55 ,"$1,324.40 ","$4,257.00 ","$1,400.00 ",$363.05 ,"$3,074.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,242.00 ","$2,107.30 ",$226.85 ,"$3,242.00 ","$2,107.30 ",$226.85 ,$907.76 ,"$1,640.45 ",$226.85 ,"$1,864.15 ",$226.85 ,"$1,640.13 ",$226.85 ,$431.02 ,"$2,658.44 ",$567.13 ,$226.85 ,"$2,755.70 ","$2,917.80 ",$226.85 ,"$2,431.50 ","$2,269.40 ","$2,399.08 ","$2,399.08 ",$567.13 ,"$2,755.70 ",$226.85 ,$226.85 ,"$2,272.64 ",$226.85 ,"$1,348.67 ", N/A ,"$2,755.70 ",$487.73 ,$907.76 ,"$2,917.80 ","$1,400.00 ",$226.85 ,"$2,107.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$1,080.80 ","$1,953.16 ",$363.05 ,"$2,219.50 ",$363.05 ,"$1,952.77 ",$363.05 ,$689.79 ,"$3,165.20 ",$907.62 ,$363.05 ,"$3,281.00 ","$3,474.00 ",$363.05 ,"$2,895.00 ","$2,702.00 ","$2,856.40 ","$2,856.40 ",$907.62 ,"$3,281.00 ",$363.05 ,$363.05 ,"$2,705.86 ",$363.05 ,"$1,605.76 ", N/A ,"$3,281.00 ",$780.55 ,"$1,080.80 ","$3,474.00 ","$1,400.00 ",$363.05 ,"$2,509.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$1,324.40 ","$2,393.38 ",$363.05 ,"$2,719.75 ",$363.05 ,"$2,392.91 ",$363.05 ,$689.79 ,"$3,878.60 ",$907.62 ,$363.05 ,"$4,020.50 ","$4,257.00 ",$363.05 ,"$3,547.50 ","$3,311.00 ","$3,500.20 ","$3,500.20 ",$907.62 ,"$4,020.50 ",$363.05 ,$363.05 ,"$3,315.73 ",$363.05 ,"$1,967.68 ", N/A ,"$4,020.50 ",$780.55 ,"$1,324.40 ","$4,257.00 ","$1,400.00 ",$363.05 ,"$3,074.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$3,242.00 ","$2,107.30 ",$226.85 ,"$3,242.00 ","$2,107.30 ",$226.85 ,$907.76 ,"$1,640.45 ",$226.85 ,"$1,864.15 ",$226.85 ,"$1,640.13 ",$226.85 ,$431.02 ,"$2,658.44 ",$567.13 ,$226.85 ,"$2,755.70 ","$2,917.80 ",$226.85 ,"$2,431.50 ","$2,269.40 ","$2,399.08 ","$2,399.08 ",$567.13 ,"$2,755.70 ",$226.85 ,$226.85 ,"$2,272.64 ",$226.85 ,"$1,348.67 ", N/A ,"$2,755.70 ",$487.73 ,$907.76 ,"$2,917.80 ","$1,400.00 ",$226.85 ,"$2,107.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$1,080.80 ","$1,953.16 ",$363.05 ,"$2,219.50 ",$363.05 ,"$1,952.77 ",$363.05 ,$689.79 ,"$3,165.20 ",$907.62 ,$363.05 ,"$3,281.00 ","$3,474.00 ",$363.05 ,"$2,895.00 ","$2,702.00 ","$2,856.40 ","$2,856.40 ",$907.62 ,"$3,281.00 ",$363.05 ,$363.05 ,"$2,705.86 ",$363.05 ,"$1,605.76 ", N/A ,"$3,281.00 ",$780.55 ,"$1,080.80 ","$3,474.00 ","$1,400.00 ",$363.05 ,"$2,509.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$1,324.40 ","$2,393.38 ",$363.05 ,"$2,719.75 ",$363.05 ,"$2,392.91 ",$363.05 ,$689.79 ,"$3,878.60 ",$907.62 ,$363.05 ,"$4,020.50 ","$4,257.00 ",$363.05 ,"$3,547.50 ","$3,311.00 ","$3,500.20 ","$3,500.20 ",$907.62 ,"$4,020.50 ",$363.05 ,$363.05 ,"$3,315.73 ",$363.05 ,"$1,967.68 ", N/A ,"$4,020.50 ",$780.55 ,"$1,324.40 ","$4,257.00 ","$1,400.00 ",$363.05 ,"$3,074.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,568.00 ","$2,319.20 ",$226.85 ,"$3,568.00 ","$2,319.20 ",$226.85 ,$999.04 ,"$1,805.41 ",$226.85 ,"$2,051.60 ",$226.85 ,"$1,805.05 ",$226.85 ,$431.02 ,"$2,925.76 ",$567.13 ,$226.85 ,"$3,032.80 ","$3,211.20 ",$226.85 ,"$2,676.00 ","$2,497.60 ","$2,640.32 ","$2,640.32 ",$567.13 ,"$3,032.80 ",$226.85 ,$226.85 ,"$2,501.17 ",$226.85 ,"$1,484.29 ", N/A ,"$3,032.80 ",$487.73 ,$999.04 ,"$3,211.20 ","$1,400.00 ",$226.85 ,"$2,319.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$1,080.80 ","$1,953.16 ",$363.05 ,"$2,219.50 ",$363.05 ,"$1,952.77 ",$363.05 ,$689.79 ,"$3,165.20 ",$907.62 ,$363.05 ,"$3,281.00 ","$3,474.00 ",$363.05 ,"$2,895.00 ","$2,702.00 ","$2,856.40 ","$2,856.40 ",$907.62 ,"$3,281.00 ",$363.05 ,$363.05 ,"$2,705.86 ",$363.05 ,"$1,605.76 ", N/A ,"$3,281.00 ",$780.55 ,"$1,080.80 ","$3,474.00 ","$1,400.00 ",$363.05 ,"$2,509.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$4,730.00 ","$3,074.50 ",$363.05 ,"$1,324.40 ","$2,393.38 ",$363.05 ,"$2,719.75 ",$363.05 ,"$2,392.91 ",$363.05 ,$689.79 ,"$3,878.60 ",$907.62 ,$363.05 ,"$4,020.50 ","$4,257.00 ",$363.05 ,"$3,547.50 ","$3,311.00 ","$3,500.20 ","$3,500.20 ",$907.62 ,"$4,020.50 ",$363.05 ,$363.05 ,"$3,315.73 ",$363.05 ,"$1,967.68 ", N/A ,"$4,020.50 ",$780.55 ,"$1,324.40 ","$4,257.00 ","$1,400.00 ",$363.05 ,"$3,074.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$3,814.00 ","$2,479.10 ",$226.85 ,"$3,814.00 ","$2,479.10 ",$226.85 ,"$1,067.92 ","$1,929.88 ",$226.85 ,"$2,193.05 ",$226.85 ,"$1,929.50 ",$226.85 ,$431.02 ,"$3,127.48 ",$567.13 ,$226.85 ,"$3,241.90 ","$3,432.60 ",$226.85 ,"$2,860.50 ","$2,669.80 ","$2,822.36 ","$2,822.36 ",$567.13 ,"$3,241.90 ",$226.85 ,$226.85 ,"$2,673.61 ",$226.85 ,"$1,586.62 ", N/A ,"$3,241.90 ",$487.73 ,"$1,067.92 ","$3,432.60 ","$1,400.00 ",$226.85 ,"$2,479.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$3,504.00 ","$2,277.60 ",$363.05 ,"$3,504.00 ","$2,277.60 ",$363.05 ,$981.12 ,"$1,773.02 ",$363.05 ,"$2,014.80 ",$363.05 ,"$1,772.67 ",$363.05 ,$689.79 ,"$2,873.28 ",$907.62 ,$363.05 ,"$2,978.40 ","$3,153.60 ",$363.05 ,"$2,628.00 ","$2,452.80 ","$2,592.96 ","$2,592.96 ",$907.62 ,"$2,978.40 ",$363.05 ,$363.05 ,"$2,456.30 ",$363.05 ,"$1,457.66 ", N/A ,"$2,978.40 ",$780.55 ,$981.12 ,"$3,153.60 ","$1,400.00 ",$363.05 ,"$2,277.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$3,402.00 ","$2,211.30 ",$226.85 ,"$3,402.00 ","$2,211.30 ",$226.85 ,$952.56 ,"$1,721.41 ",$226.85 ,"$1,956.15 ",$226.85 ,"$1,721.07 ",$226.85 ,$431.02 ,"$2,789.64 ",$567.13 ,$226.85 ,"$2,891.70 ","$3,061.80 ",$226.85 ,"$2,551.50 ","$2,381.40 ","$2,517.48 ","$2,517.48 ",$567.13 ,"$2,891.70 ",$226.85 ,$226.85 ,"$2,384.80 ",$226.85 ,"$1,415.23 ", N/A ,"$2,891.70 ",$487.73 ,$952.56 ,"$3,061.80 ","$1,400.00 ",$226.85 ,"$2,211.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$3,574.00 ","$2,323.10 ",$363.05 ,"$3,574.00 ","$2,323.10 ",$363.05 ,"$1,000.72 ","$1,808.44 ",$363.05 ,"$2,055.05 ",$363.05 ,"$1,808.09 ",$363.05 ,$689.79 ,"$2,930.68 ",$907.62 ,$363.05 ,"$3,037.90 ","$3,216.60 ",$363.05 ,"$2,680.50 ","$2,501.80 ","$2,644.76 ","$2,644.76 ",$907.62 ,"$3,037.90 ",$363.05 ,$363.05 ,"$2,505.37 ",$363.05 ,"$1,486.78 ", N/A ,"$3,037.90 ",$780.55 ,"$1,000.72 ","$3,216.60 ","$1,400.00 ",$363.05 ,"$2,323.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$3,402.00 ","$2,211.30 ",$226.85 ,"$3,402.00 ","$2,211.30 ",$226.85 ,$952.56 ,"$1,721.41 ",$226.85 ,"$1,956.15 ",$226.85 ,"$1,721.07 ",$226.85 ,$431.02 ,"$2,789.64 ",$567.13 ,$226.85 ,"$2,891.70 ","$3,061.80 ",$226.85 ,"$2,551.50 ","$2,381.40 ","$2,517.48 ","$2,517.48 ",$567.13 ,"$2,891.70 ",$226.85 ,$226.85 ,"$2,384.80 ",$226.85 ,"$1,415.23 ", N/A ,"$2,891.70 ",$487.73 ,$952.56 ,"$3,061.80 ","$1,400.00 ",$226.85 ,"$2,211.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$4,684.00 ","$3,044.60 ",$363.05 ,"$4,684.00 ","$3,044.60 ",$363.05 ,"$1,311.52 ","$2,370.10 ",$363.05 ,"$2,693.30 ",$363.05 ,"$2,369.64 ",$363.05 ,$689.79 ,"$3,840.88 ",$907.62 ,$363.05 ,"$3,981.40 ","$4,215.60 ",$363.05 ,"$3,513.00 ","$3,278.80 ","$3,466.16 ","$3,466.16 ",$907.62 ,"$3,981.40 ",$363.05 ,$363.05 ,"$3,283.48 ",$363.05 ,"$1,948.54 ", N/A ,"$3,981.40 ",$780.55 ,"$1,311.52 ","$4,215.60 ","$1,400.00 ",$363.05 ,"$3,044.60 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$1,263.08 ","$2,282.57 ",$363.05 ,"$2,593.83 ",$363.05 ,"$2,282.11 ",$363.05 ,$689.79 ,"$3,699.02 ",$907.62 ,$363.05 ,"$3,834.35 ","$4,059.90 ",$363.05 ,"$3,383.25 ","$3,157.70 ","$3,338.14 ","$3,338.14 ",$907.62 ,"$3,834.35 ",$363.05 ,$363.05 ,"$3,162.21 ",$363.05 ,"$1,876.58 ", N/A ,"$3,834.35 ",$780.55 ,"$1,263.08 ","$4,059.90 ","$1,400.00 ",$363.05 ,"$2,932.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$1,263.08 ","$2,282.57 ",$363.05 ,"$2,593.83 ",$363.05 ,"$2,282.11 ",$363.05 ,$689.79 ,"$3,699.02 ",$907.62 ,$363.05 ,"$3,834.35 ","$4,059.90 ",$363.05 ,"$3,383.25 ","$3,157.70 ","$3,338.14 ","$3,338.14 ",$907.62 ,"$3,834.35 ",$363.05 ,$363.05 ,"$3,162.21 ",$363.05 ,"$1,876.58 ", N/A ,"$3,834.35 ",$780.55 ,"$1,263.08 ","$4,059.90 ","$1,400.00 ",$363.05 ,"$2,932.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$3,255.00 ","$2,115.75 ",$226.85 ,"$3,255.00 ","$2,115.75 ",$226.85 ,$911.40 ,"$1,647.03 ",$226.85 ,"$1,871.63 ",$226.85 ,"$1,646.70 ",$226.85 ,$431.02 ,"$2,669.10 ",$567.13 ,$226.85 ,"$2,766.75 ","$2,929.50 ",$226.85 ,"$2,441.25 ","$2,278.50 ","$2,408.70 ","$2,408.70 ",$567.13 ,"$2,766.75 ",$226.85 ,$226.85 ,"$2,281.76 ",$226.85 ,"$1,354.08 ", N/A ,"$2,766.75 ",$487.73 ,$911.40 ,"$2,929.50 ","$1,400.00 ",$226.85 ,"$2,115.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$3,521.00 ","$2,288.65 ",$363.05 ,"$3,521.00 ","$2,288.65 ",$363.05 ,$985.88 ,"$1,781.63 ",$363.05 ,"$2,024.58 ",$363.05 ,"$1,781.27 ",$363.05 ,$689.79 ,"$2,887.22 ",$907.62 ,$363.05 ,"$2,992.85 ","$3,168.90 ",$363.05 ,"$2,640.75 ","$2,464.70 ","$2,605.54 ","$2,605.54 ",$907.62 ,"$2,992.85 ",$363.05 ,$363.05 ,"$2,468.22 ",$363.05 ,"$1,464.74 ", N/A ,"$2,992.85 ",$780.55 ,$985.88 ,"$3,168.90 ","$1,400.00 ",$363.05 ,"$2,288.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$4,315.00 ","$2,804.75 ",$363.05 ,"$4,315.00 ","$2,804.75 ",$363.05 ,"$1,208.20 ","$2,183.39 ",$363.05 ,"$2,481.13 ",$363.05 ,"$2,182.96 ",$363.05 ,$689.79 ,"$3,538.30 ",$907.62 ,$363.05 ,"$3,667.75 ","$3,883.50 ",$363.05 ,"$3,236.25 ","$3,020.50 ","$3,193.10 ","$3,193.10 ",$907.62 ,"$3,667.75 ",$363.05 ,$363.05 ,"$3,024.82 ",$363.05 ,"$1,795.04 ", N/A ,"$3,667.75 ",$780.55 ,"$1,208.20 ","$3,883.50 ","$1,400.00 ",$363.05 ,"$2,804.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$3,402.00 ","$2,211.30 ",$226.85 ,"$3,402.00 ","$2,211.30 ",$226.85 ,$952.56 ,"$1,721.41 ",$226.85 ,"$1,956.15 ",$226.85 ,"$1,721.07 ",$226.85 ,$431.02 ,"$2,789.64 ",$567.13 ,$226.85 ,"$2,891.70 ","$3,061.80 ",$226.85 ,"$2,551.50 ","$2,381.40 ","$2,517.48 ","$2,517.48 ",$567.13 ,"$2,891.70 ",$226.85 ,$226.85 ,"$2,384.80 ",$226.85 ,"$1,415.23 ", N/A ,"$2,891.70 ",$487.73 ,$952.56 ,"$3,061.80 ","$1,400.00 ",$226.85 ,"$2,211.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$3,681.00 ","$2,392.65 ",$363.05 ,"$3,681.00 ","$2,392.65 ",$363.05 ,"$1,030.68 ","$1,862.59 ",$363.05 ,"$2,116.58 ",$363.05 ,"$1,862.22 ",$363.05 ,$689.79 ,"$3,018.42 ",$907.62 ,$363.05 ,"$3,128.85 ","$3,312.90 ",$363.05 ,"$2,760.75 ","$2,576.70 ","$2,723.94 ","$2,723.94 ",$907.62 ,"$3,128.85 ",$363.05 ,$363.05 ,"$2,580.38 ",$363.05 ,"$1,531.30 ", N/A ,"$3,128.85 ",$780.55 ,"$1,030.68 ","$3,312.90 ","$1,400.00 ",$363.05 ,"$2,392.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$363.05 ,"$4,646.00 ","$3,019.90 ",$363.05 ,"$1,300.88 ","$2,350.88 ",$363.05 ,"$2,671.45 ",$363.05 ,"$2,350.41 ",$363.05 ,$689.79 ,"$3,809.72 ",$907.62 ,$363.05 ,"$3,949.10 ","$4,181.40 ",$363.05 ,"$3,484.50 ","$3,252.20 ","$3,438.04 ","$3,438.04 ",$907.62 ,"$3,949.10 ",$363.05 ,$363.05 ,"$3,256.85 ",$363.05 ,"$1,932.74 ", N/A ,"$3,949.10 ",$780.55 ,"$1,300.88 ","$4,181.40 ","$1,400.00 ",$363.05 ,"$3,019.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$3,566.00 ","$2,317.90 ",$226.85 ,"$3,566.00 ","$2,317.90 ",$226.85 ,$998.48 ,"$1,804.40 ",$226.85 ,"$2,050.45 ",$226.85 ,"$1,804.04 ",$226.85 ,$431.02 ,"$2,924.12 ",$567.13 ,$226.85 ,"$3,031.10 ","$3,209.40 ",$226.85 ,"$2,674.50 ","$2,496.20 ","$2,638.84 ","$2,638.84 ",$567.13 ,"$3,031.10 ",$226.85 ,$226.85 ,"$2,499.77 ",$226.85 ,"$1,483.46 ", N/A ,"$3,031.10 ",$487.73 ,$998.48 ,"$3,209.40 ","$1,400.00 ",$226.85 ,"$2,317.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$3,574.00 ","$2,323.10 ",$705.33 ,"$3,574.00 ","$2,323.10 ",$705.33 ,"$1,000.72 ","$1,808.44 ",$705.33 ,"$2,055.05 ",$705.33 ,"$1,808.09 ",$705.33 ,"$1,340.13 ","$2,930.68 ","$1,763.33 ",$705.33 ,"$3,037.90 ","$3,216.60 ",$705.33 ,"$2,680.50 ","$2,501.80 ","$2,644.76 ","$2,644.76 ","$1,763.33 ","$3,037.90 ",$705.33 ,$705.33 ,"$2,505.37 ",$705.33 ,"$1,486.78 ", N/A ,"$3,037.90 ","$1,516.46 ","$1,000.72 ","$3,216.60 ","$1,400.00 ",$705.33 ,"$2,323.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$1,263.08 ","$2,282.57 ",$363.05 ,"$2,593.83 ",$363.05 ,"$2,282.11 ",$363.05 ,$689.79 ,"$3,699.02 ",$907.62 ,$363.05 ,"$3,834.35 ","$4,059.90 ",$363.05 ,"$3,383.25 ","$3,157.70 ","$3,338.14 ","$3,338.14 ",$907.62 ,"$3,834.35 ",$363.05 ,$363.05 ,"$3,162.21 ",$363.05 ,"$1,876.58 ", N/A ,"$3,834.35 ",$780.55 ,"$1,263.08 ","$4,059.90 ","$1,400.00 ",$363.05 ,"$2,932.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$3,402.00 ","$2,211.30 ",$226.85 ,"$3,402.00 ","$2,211.30 ",$226.85 ,$952.56 ,"$1,721.41 ",$226.85 ,"$1,956.15 ",$226.85 ,"$1,721.07 ",$226.85 ,$431.02 ,"$2,789.64 ",$567.13 ,$226.85 ,"$2,891.70 ","$3,061.80 ",$226.85 ,"$2,551.50 ","$2,381.40 ","$2,517.48 ","$2,517.48 ",$567.13 ,"$2,891.70 ",$226.85 ,$226.85 ,"$2,384.80 ",$226.85 ,"$1,415.23 ", N/A ,"$2,891.70 ",$487.73 ,$952.56 ,"$3,061.80 ","$1,400.00 ",$226.85 ,"$2,211.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$3,681.00 ","$2,392.65 ",$363.05 ,"$3,681.00 ","$2,392.65 ",$363.05 ,"$1,030.68 ","$1,862.59 ",$363.05 ,"$2,116.58 ",$363.05 ,"$1,862.22 ",$363.05 ,$689.79 ,"$3,018.42 ",$907.62 ,$363.05 ,"$3,128.85 ","$3,312.90 ",$363.05 ,"$2,760.75 ","$2,576.70 ","$2,723.94 ","$2,723.94 ",$907.62 ,"$3,128.85 ",$363.05 ,$363.05 ,"$2,580.38 ",$363.05 ,"$1,531.30 ", N/A ,"$3,128.85 ",$780.55 ,"$1,030.68 ","$3,312.90 ","$1,400.00 ",$363.05 ,"$2,392.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$1,263.08 ","$2,282.57 ",$363.05 ,"$2,593.83 ",$363.05 ,"$2,282.11 ",$363.05 ,$689.79 ,"$3,699.02 ",$907.62 ,$363.05 ,"$3,834.35 ","$4,059.90 ",$363.05 ,"$3,383.25 ","$3,157.70 ","$3,338.14 ","$3,338.14 ",$907.62 ,"$3,834.35 ",$363.05 ,$363.05 ,"$3,162.21 ",$363.05 ,"$1,876.58 ", N/A ,"$3,834.35 ",$780.55 ,"$1,263.08 ","$4,059.90 ","$1,400.00 ",$363.05 ,"$2,932.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$3,566.00 ","$2,317.90 ",$226.85 ,"$3,566.00 ","$2,317.90 ",$226.85 ,$998.48 ,"$1,804.40 ",$226.85 ,"$2,050.45 ",$226.85 ,"$1,804.04 ",$226.85 ,$431.02 ,"$2,924.12 ",$567.13 ,$226.85 ,"$3,031.10 ","$3,209.40 ",$226.85 ,"$2,674.50 ","$2,496.20 ","$2,638.84 ","$2,638.84 ",$567.13 ,"$3,031.10 ",$226.85 ,$226.85 ,"$2,499.77 ",$226.85 ,"$1,483.46 ", N/A ,"$3,031.10 ",$487.73 ,$998.48 ,"$3,209.40 ","$1,400.00 ",$226.85 ,"$2,317.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$3,574.00 ","$2,323.10 ",$705.33 ,"$3,574.00 ","$2,323.10 ",$705.33 ,"$1,000.72 ","$1,808.44 ",$705.33 ,"$2,055.05 ",$705.33 ,"$1,808.09 ",$705.33 ,"$1,340.13 ","$2,930.68 ","$1,763.33 ",$705.33 ,"$3,037.90 ","$3,216.60 ",$705.33 ,"$2,680.50 ","$2,501.80 ","$2,644.76 ","$2,644.76 ","$1,763.33 ","$3,037.90 ",$705.33 ,$705.33 ,"$2,505.37 ",$705.33 ,"$1,486.78 ", N/A ,"$3,037.90 ","$1,516.46 ","$1,000.72 ","$3,216.60 ","$1,400.00 ",$705.33 ,"$2,323.10 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$4,511.00 ","$2,932.15 ",$363.05 ,"$1,263.08 ","$2,282.57 ",$363.05 ,"$2,593.83 ",$363.05 ,"$2,282.11 ",$363.05 ,$689.79 ,"$3,699.02 ",$907.62 ,$363.05 ,"$3,834.35 ","$4,059.90 ",$363.05 ,"$3,383.25 ","$3,157.70 ","$3,338.14 ","$3,338.14 ",$907.62 ,"$3,834.35 ",$363.05 ,$363.05 ,"$3,162.21 ",$363.05 ,"$1,876.58 ", N/A ,"$3,834.35 ",$780.55 ,"$1,263.08 ","$4,059.90 ","$1,400.00 ",$363.05 ,"$2,932.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,255.00 ","$2,115.75 ",$226.85 ,"$3,255.00 ","$2,115.75 ",$226.85 ,$911.40 ,"$1,647.03 ",$226.85 ,"$1,871.63 ",$226.85 ,"$1,646.70 ",$226.85 ,$431.02 ,"$2,669.10 ",$567.13 ,$226.85 ,"$2,766.75 ","$2,929.50 ",$226.85 ,"$2,441.25 ","$2,278.50 ","$2,408.70 ","$2,408.70 ",$567.13 ,"$2,766.75 ",$226.85 ,$226.85 ,"$2,281.76 ",$226.85 ,"$1,354.08 ", N/A ,"$2,766.75 ",$487.73 ,$911.40 ,"$2,929.50 ","$1,400.00 ",$226.85 ,"$2,115.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$4,315.00 ","$2,804.75 ",$363.05 ,"$4,315.00 ","$2,804.75 ",$363.05 ,"$1,208.20 ","$2,183.39 ",$363.05 ,"$2,481.13 ",$363.05 ,"$2,182.96 ",$363.05 ,$689.79 ,"$3,538.30 ",$907.62 ,$363.05 ,"$3,667.75 ","$3,883.50 ",$363.05 ,"$3,236.25 ","$3,020.50 ","$3,193.10 ","$3,193.10 ",$907.62 ,"$3,667.75 ",$363.05 ,$363.05 ,"$3,024.82 ",$363.05 ,"$1,795.04 ", N/A ,"$3,667.75 ",$780.55 ,"$1,208.20 ","$3,883.50 ","$1,400.00 ",$363.05 ,"$2,804.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000042,75561,HC MRI CARD W/O AND W CON,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000050,C8937,HC MRI BREAST CAD,610,1 ,$302.00 ,$196.30 ,$84.56 ,$302.00 ,$196.30 , N/A ,$84.56 ,$152.81 , N/A ,$173.65 , N/A ,$152.78 , N/A , N/A ,$247.64 , N/A , N/A ,$256.70 ,$271.80 , N/A ,$226.50 ,$211.40 ,$223.48 ,$223.48 , N/A ,$256.70 , N/A , N/A ,$211.70 , N/A ,$125.63 , N/A ,$256.70 , N/A ,$84.56 ,$271.80 ,$302.00 , N/A ,$196.30 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,521.00 ","$2,288.65 ",$363.05 ,"$3,521.00 ","$2,288.65 ",$363.05 ,$985.88 ,"$1,781.63 ",$363.05 ,"$2,024.58 ",$363.05 ,"$1,781.27 ",$363.05 ,$689.79 ,"$2,887.22 ",$907.62 ,$363.05 ,"$2,992.85 ","$3,168.90 ",$363.05 ,"$2,640.75 ","$2,464.70 ","$2,605.54 ","$2,605.54 ",$907.62 ,"$2,992.85 ",$363.05 ,$363.05 ,"$2,468.22 ",$363.05 ,"$1,464.74 ", N/A ,"$2,992.85 ",$780.55 ,$985.88 ,"$3,168.90 ","$1,400.00 ",$363.05 ,"$2,288.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$2,770.00 ","$1,800.50 ",$226.85 ,"$2,770.00 ","$1,800.50 ",$226.85 ,$775.60 ,"$1,401.62 ",$226.85 ,"$1,592.75 ",$226.85 ,"$1,401.34 ",$226.85 ,$431.02 ,"$2,271.40 ",$567.13 ,$226.85 ,"$2,354.50 ","$2,493.00 ",$226.85 ,"$2,077.50 ","$1,939.00 ","$2,049.80 ","$2,049.80 ",$567.13 ,"$2,354.50 ",$226.85 ,$226.85 ,"$1,941.77 ",$226.85 ,"$1,152.32 ", N/A ,"$2,354.50 ",$487.73 ,$775.60 ,"$2,493.00 ","$1,400.00 ",$226.85 ,"$1,800.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000054,C8903,HC MRI BREAST UNI W/CONTRAST,610,1 ,$519.00 ,$337.35 ,$145.32 ,$519.00 ,$337.35 ,$176.10 ,$145.32 ,$262.61 ,$176.10 ,$298.43 ,$176.10 ,$262.56 ,$176.10 ,$334.60 ,$425.58 ,$440.26 ,$176.10 ,$441.15 ,$467.10 ,$176.10 ,$389.25 ,$363.30 ,$384.06 ,$384.06 ,$440.26 ,$441.15 ,$176.10 ,$176.10 ,$363.82 ,$176.10 ,$215.90 , N/A ,$441.15 ,$378.62 ,$145.32 ,$467.10 ,$519.00 ,$176.10 ,$337.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000055,77046,HC MRI BREAST UNI W/O CON,610,1 ,$669.00 ,$434.85 ,$187.32 ,$669.00 ,$434.85 ,$226.85 ,$187.32 ,$338.51 ,$226.85 ,$384.68 ,$226.85 ,$338.45 ,$226.85 ,$431.02 ,$548.58 ,$567.13 ,$226.85 ,$568.65 ,$602.10 ,$226.85 ,$501.75 ,$468.30 ,$495.06 ,$495.06 ,$567.13 ,$568.65 ,$226.85 ,$226.85 ,$468.97 ,$226.85 ,$278.30 , N/A ,$568.65 ,$487.73 ,$187.32 ,$602.10 ,$669.00 ,$226.85 ,$434.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000056,C8905,HC MRI BREAST UNI W AND W/O CONTRAST,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000057,C8906,HC MRI BREAST BIL W/CONTRAST,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,$669.00 ,$434.85 ,$187.32 ,$669.00 ,$434.85 ,$226.85 ,$187.32 ,$338.51 ,$226.85 ,$384.68 ,$226.85 ,$338.45 ,$226.85 ,$431.02 ,$548.58 ,$567.13 ,$226.85 ,$568.65 ,$602.10 ,$226.85 ,$501.75 ,$468.30 ,$495.06 ,$495.06 ,$567.13 ,$568.65 ,$226.85 ,$226.85 ,$468.97 ,$226.85 ,$278.30 , N/A ,$568.65 ,$487.73 ,$187.32 ,$602.10 ,$669.00 ,$226.85 ,$434.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000061,C8910,HC MRA CHEST W/O CONTRAST,610,1 ,"$2,770.00 ","$1,800.50 ",$226.85 ,"$2,770.00 ","$1,800.50 ",$226.85 ,$775.60 ,"$1,401.62 ",$226.85 ,"$1,592.75 ",$226.85 ,"$1,401.34 ",$226.85 ,$431.02 ,"$2,271.40 ",$567.13 ,$226.85 ,"$2,354.50 ","$2,493.00 ",$226.85 ,"$2,077.50 ","$1,939.00 ","$2,049.80 ","$2,049.80 ",$567.13 ,"$2,354.50 ",$226.85 ,$226.85 ,"$1,941.77 ",$226.85 ,"$1,152.32 ", N/A ,"$2,354.50 ",$487.73 ,$775.60 ,"$2,493.00 ","$1,400.00 ",$226.85 ,"$1,800.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$3,521.00 ","$2,288.65 ",$363.05 ,"$3,521.00 ","$2,288.65 ",$363.05 ,$985.88 ,"$1,781.63 ",$363.05 ,"$2,024.58 ",$363.05 ,"$1,781.27 ",$363.05 ,$689.79 ,"$2,887.22 ",$907.62 ,$363.05 ,"$2,992.85 ","$3,168.90 ",$363.05 ,"$2,640.75 ","$2,464.70 ","$2,605.54 ","$2,605.54 ",$907.62 ,"$2,992.85 ",$363.05 ,$363.05 ,"$2,468.22 ",$363.05 ,"$1,464.74 ", N/A ,"$2,992.85 ",$780.55 ,$985.88 ,"$3,168.90 ","$1,400.00 ",$363.05 ,"$2,288.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$3,047.00 ","$1,980.55 ",$226.85 ,"$3,047.00 ","$1,980.55 ",$226.85 ,$853.16 ,"$1,541.78 ",$226.85 ,"$1,752.03 ",$226.85 ,"$1,541.48 ",$226.85 ,$431.02 ,"$2,498.54 ",$567.13 ,$226.85 ,"$2,589.95 ","$2,742.30 ",$226.85 ,"$2,285.25 ","$2,132.90 ","$2,254.78 ","$2,254.78 ",$567.13 ,"$2,589.95 ",$226.85 ,$226.85 ,"$2,135.95 ",$226.85 ,"$1,267.55 ", N/A ,"$2,589.95 ",$487.73 ,$853.16 ,"$2,742.30 ","$1,400.00 ",$226.85 ,"$1,980.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$4,040.00 ","$2,626.00 ",$363.05 ,"$4,040.00 ","$2,626.00 ",$363.05 ,"$1,131.20 ","$2,044.24 ",$363.05 ,"$2,323.00 ",$363.05 ,"$2,043.84 ",$363.05 ,$689.79 ,"$3,312.80 ",$907.62 ,$363.05 ,"$3,434.00 ","$3,636.00 ",$363.05 ,"$3,030.00 ","$2,828.00 ","$2,989.60 ","$2,989.60 ",$907.62 ,"$3,434.00 ",$363.05 ,$363.05 ,"$2,832.04 ",$363.05 ,"$1,680.64 ", N/A ,"$3,434.00 ",$780.55 ,"$1,131.20 ","$3,636.00 ","$1,400.00 ",$363.05 ,"$2,626.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,201.00 ","$2,080.65 ",$363.05 ,"$3,201.00 ","$2,080.65 ",$363.05 ,$896.28 ,"$1,619.71 ",$363.05 ,"$1,840.58 ",$363.05 ,"$1,619.39 ",$363.05 ,$689.79 ,"$2,624.82 ",$907.62 ,$363.05 ,"$2,720.85 ","$2,880.90 ",$363.05 ,"$2,400.75 ","$2,240.70 ","$2,368.74 ","$2,368.74 ",$907.62 ,"$2,720.85 ",$363.05 ,$363.05 ,"$2,243.90 ",$363.05 ,"$1,331.62 ", N/A ,"$2,720.85 ",$780.55 ,$896.28 ,"$2,880.90 ","$1,400.00 ",$363.05 ,"$2,080.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000069,C8919,HC MRA PELVIS W/O CON,610,1 ,"$2,770.00 ","$1,800.50 ",$226.85 ,"$2,770.00 ","$1,800.50 ",$226.85 ,$775.60 ,"$1,401.62 ",$226.85 ,"$1,592.75 ",$226.85 ,"$1,401.34 ",$226.85 ,$431.02 ,"$2,271.40 ",$567.13 ,$226.85 ,"$2,354.50 ","$2,493.00 ",$226.85 ,"$2,077.50 ","$1,939.00 ","$2,049.80 ","$2,049.80 ",$567.13 ,"$2,354.50 ",$226.85 ,$226.85 ,"$1,941.77 ",$226.85 ,"$1,152.32 ", N/A ,"$2,354.50 ",$487.73 ,$775.60 ,"$2,493.00 ","$1,400.00 ",$226.85 ,"$1,800.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000070,C8920,HC MRA PELVIS W AND W/O CONTRAST,610,1 ,"$4,040.00 ","$2,626.00 ",$363.05 ,"$4,040.00 ","$2,626.00 ",$363.05 ,"$1,131.20 ","$2,044.24 ",$363.05 ,"$2,323.00 ",$363.05 ,"$2,043.84 ",$363.05 ,$689.79 ,"$3,312.80 ",$907.62 ,$363.05 ,"$3,434.00 ","$3,636.00 ",$363.05 ,"$3,030.00 ","$2,828.00 ","$2,989.60 ","$2,989.60 ",$907.62 ,"$3,434.00 ",$363.05 ,$363.05 ,"$2,832.04 ",$363.05 ,"$1,680.64 ", N/A ,"$3,434.00 ",$780.55 ,"$1,131.20 ","$3,636.00 ","$1,400.00 ",$363.05 ,"$2,626.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000071,C8934,HC MRA UPPR EXT W/CONTRAST,610,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$4,872.00 ","$3,166.80 ",$363.05 ,"$4,872.00 ","$3,166.80 ",$363.05 ,"$1,364.16 ","$2,465.23 ",$363.05 ,"$2,801.40 ",$363.05 ,"$2,464.74 ",$363.05 ,$689.79 ,"$3,995.04 ",$907.62 ,$363.05 ,"$4,141.20 ","$4,384.80 ",$363.05 ,"$3,654.00 ","$3,410.40 ","$3,605.28 ","$3,605.28 ",$907.62 ,"$4,141.20 ",$363.05 ,$363.05 ,"$3,415.27 ",$363.05 ,"$2,026.75 ", N/A ,"$4,141.20 ",$780.55 ,"$1,364.16 ","$4,384.80 ","$1,400.00 ",$363.05 ,"$3,166.80 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$3,860.00 ","$2,509.00 ",$363.05 ,"$1,080.80 ","$1,953.16 ",$363.05 ,"$2,219.50 ",$363.05 ,"$1,952.77 ",$363.05 ,$689.79 ,"$3,165.20 ",$907.62 ,$363.05 ,"$3,281.00 ","$3,474.00 ",$363.05 ,"$2,895.00 ","$2,702.00 ","$2,856.40 ","$2,856.40 ",$907.62 ,"$3,281.00 ",$363.05 ,$363.05 ,"$2,705.86 ",$363.05 ,"$1,605.76 ", N/A ,"$3,281.00 ",$780.55 ,"$1,080.80 ","$3,474.00 ","$1,400.00 ",$363.05 ,"$2,509.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),61000077,74712,HC MRI FETAL PLACENTA/MATERN PELVIC SINGLE,610,1 ,$669.00 ,$434.85 ,$187.32 ,$669.00 ,$434.85 ,$226.85 ,$187.32 ,$338.51 ,$226.85 ,$384.68 ,$226.85 ,$338.45 ,$226.85 ,$431.02 ,$548.58 ,$567.13 ,$226.85 ,$568.65 ,$602.10 ,$226.85 ,$501.75 ,$468.30 ,$495.06 ,$495.06 ,$567.13 ,$568.65 ,$226.85 ,$226.85 ,$468.97 ,$226.85 ,$278.30 , N/A ,$568.65 ,$487.73 ,$187.32 ,$602.10 ,$669.00 ,$226.85 ,$434.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61800004,C8935,HC MRA UPPR EXT W/O CONTRAST,618,1 ,$669.00 ,$434.85 ,$187.32 ,$669.00 ,$434.85 ,$226.85 ,$187.32 ,$338.51 ,$226.85 ,$384.68 ,$226.85 ,$338.45 ,$226.85 ,$431.02 ,$548.58 ,$567.13 ,$226.85 ,$568.65 ,$602.10 ,$226.85 ,$501.75 ,$468.30 ,$495.06 ,$495.06 ,$567.13 ,$568.65 ,$226.85 ,$226.85 ,$468.97 ,$226.85 ,$278.30 , N/A ,$568.65 ,$487.73 ,$187.32 ,$602.10 ,$669.00 ,$226.85 ,$434.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),61800005,C8936,HC MRA UPPR EXT W/  AND  W/O CONTRAST,618,1 ,"$1,070.00 ",$695.50 ,$299.60 ,"$1,070.00 ",$695.50 ,$363.05 ,$299.60 ,$541.42 ,$363.05 ,$615.25 ,$363.05 ,$541.31 ,$363.05 ,$689.79 ,$877.40 ,$907.62 ,$363.05 ,$909.50 ,$963.00 ,$363.05 ,$802.50 ,$749.00 ,$791.80 ,$791.80 ,$907.62 ,$909.50 ,$363.05 ,$363.05 ,$750.07 ,$363.05 ,$445.12 , N/A ,$909.50 ,$780.55 ,$299.60 ,$963.00 ,"$1,070.00 ",$363.05 ,$695.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),62200026,N/A,HC HOT BIOPSY FORCEPS,621,1 ,$71.00 ,$46.15 ,$19.88 ,$71.00 ,$46.15 , N/A ,$19.88 ,$35.93 , N/A ,$40.83 , N/A ,$35.92 , N/A , N/A ,$58.22 , N/A , N/A ,$60.35 ,$63.90 , N/A ,$53.25 ,$49.70 ,$52.54 ,$52.54 , N/A ,$60.35 , N/A , N/A ,$49.77 , N/A ,$29.54 , N/A ,$60.35 , N/A ,$19.88 ,$63.90 ,$37.49 , N/A ,$46.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),71000230,N/A,HC PHASE II RECOVERY 15 MIN,710,1 ,$167.00 ,$108.55 ,$46.76 ,$167.00 ,$108.55 , N/A ,$46.76 ,$84.50 , N/A ,$96.03 , N/A ,$84.49 , N/A , N/A ,$136.94 , N/A , N/A ,$141.95 ,$150.30 , N/A ,$125.25 ,$116.90 ,$123.58 ,$123.58 , N/A ,$141.95 , N/A , N/A ,$117.07 , N/A ,$69.47 , N/A ,$141.95 , N/A ,$46.76 ,$150.30 ,$88.18 , N/A ,$108.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),71000233,N/A,HC PHASE I RECOVERY 30 MIN,710,1 ,"$1,279.00 ",$831.35 ,$358.12 ,"$1,279.00 ",$831.35 , N/A ,$358.12 ,$647.17 , N/A ,$735.43 , N/A ,$647.05 , N/A , N/A ,"$1,048.78 ", N/A , N/A ,"$1,087.15 ","$1,151.10 ", N/A ,$959.25 ,$895.30 ,$946.46 ,$946.46 , N/A ,"$1,087.15 ", N/A , N/A ,$896.58 , N/A ,$532.06 , N/A ,"$1,087.15 ", N/A ,$358.12 ,"$1,151.10 ",$675.31 , N/A ,$831.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),71000234,N/A,HC PHASE I RECOVERY 15 MIN,710,1 ,$247.00 ,$160.55 ,$69.16 ,$247.00 ,$160.55 , N/A ,$69.16 ,$124.98 , N/A ,$142.03 , N/A ,$124.96 , N/A , N/A ,$202.54 , N/A , N/A ,$209.95 ,$222.30 , N/A ,$185.25 ,$172.90 ,$182.78 ,$182.78 , N/A ,$209.95 , N/A , N/A ,$173.15 , N/A ,$102.75 , N/A ,$209.95 , N/A ,$69.16 ,$222.30 ,$130.42 , N/A ,$160.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),73000002,93005,HC EKG,730,1 ,$306.00 ,$198.90 ,$54.88 ,$306.00 ,$198.90 ,$54.88 ,$85.68 ,$154.84 ,$54.88 ,$175.95 ,$54.88 ,$154.81 ,$54.88 ,$104.27 ,$250.92 ,$137.20 ,$54.88 ,$260.10 ,$275.40 ,$54.88 ,$229.50 ,$214.20 ,$226.44 ,$226.44 ,$137.20 ,$260.10 ,$54.88 ,$54.88 ,$214.51 ,$54.88 ,$127.30 , N/A ,$260.10 ,$117.99 ,$85.68 ,$275.40 ,$306.00 ,$54.88 ,$198.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),73000003,93041,HC EKG RHYTHM STRIP TRACING,730,1 ,$229.00 ,$148.85 ,$54.88 ,$229.00 ,$148.85 ,$54.88 ,$64.12 ,$115.87 ,$54.88 ,$131.68 ,$54.88 ,$115.85 ,$54.88 ,$104.27 ,$187.78 ,$137.20 ,$54.88 ,$194.65 ,$206.10 ,$54.88 ,$171.75 ,$160.30 ,$169.46 ,$169.46 ,$137.20 ,$194.65 ,$54.88 ,$54.88 ,$160.53 ,$54.88 ,$95.26 , N/A ,$194.65 ,$117.99 ,$64.12 ,$206.10 ,$229.00 ,$54.88 ,$148.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,"$1,750.00 ","$1,137.50 ",$111.17 ,"$1,750.00 ","$1,137.50 ",$111.17 ,$490.00 ,$885.50 ,$111.17 ,"$1,006.25 ",$111.17 ,$885.33 ,$111.17 ,$211.22 ,"$1,435.00 ",$277.92 ,$111.17 ,"$1,487.50 ","$1,575.00 ",$111.17 ,"$1,312.50 ","$1,225.00 ","$1,295.00 ","$1,295.00 ",$277.92 ,"$1,487.50 ",$111.17 ,$111.17 ,"$1,226.75 ",$111.17 ,$728.00 , N/A ,"$1,487.50 ",$239.01 ,$490.00 ,"$1,575.00 ",$725.00 ,$111.17 ,"$1,137.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),73100001,93226,HC HOLTER SCAN  AND  REPORT 24 HR,731,1 ,$511.00 ,$332.15 ,$111.17 ,$511.00 ,$332.15 ,$111.17 ,$143.08 ,$258.57 ,$111.17 ,$293.83 ,$111.17 ,$258.51 ,$111.17 ,$211.22 ,$419.02 ,$277.92 ,$111.17 ,$434.35 ,$459.90 ,$111.17 ,$383.25 ,$357.70 ,$378.14 ,$378.14 ,$277.92 ,$434.35 ,$111.17 ,$111.17 ,$358.21 ,$111.17 ,$212.58 , N/A ,$434.35 ,$239.01 ,$143.08 ,$459.90 ,$511.00 ,$111.17 ,$332.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$511.00 ,$332.15 ,$111.17 ,$511.00 ,$332.15 ,$111.17 ,$143.08 ,$258.57 ,$111.17 ,$293.83 ,$111.17 ,$258.51 ,$111.17 ,$211.22 ,$419.02 ,$277.92 ,$111.17 ,$434.35 ,$459.90 ,$111.17 ,$383.25 ,$357.70 ,$378.14 ,$378.14 ,$277.92 ,$434.35 ,$111.17 ,$111.17 ,$358.21 ,$111.17 ,$212.58 , N/A ,$434.35 ,$239.01 ,$143.08 ,$459.90 ,$511.00 ,$111.17 ,$332.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),74000002,95805,HC MULTIPLE SLEEP LATENCY,740,1 ,"$4,097.00 ","$2,663.05 ",$481.24 ,"$4,097.00 ","$2,663.05 ",$481.24 ,"$1,147.16 ","$2,073.08 ",$481.24 ,"$2,355.78 ",$481.24 ,"$2,072.67 ",$481.24 ,$914.36 ,"$3,359.54 ","$1,203.10 ",$481.24 ,"$3,482.45 ","$3,687.30 ",$481.24 ,"$3,072.75 ","$2,867.90 ","$3,031.78 ","$3,031.78 ","$1,203.10 ","$3,482.45 ",$481.24 ,$481.24 ,"$2,872.00 ",$481.24 ,"$1,704.35 ", N/A ,"$3,482.45 ","$1,034.67 ","$1,147.16 ","$3,687.30 ","$2,508.00 ",$481.24 ,"$2,663.05 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),74000003,95806,HC SLEEP STUDY UNATTENDED,740,1 ,$397.00 ,$258.05 ,$111.16 ,$397.00 ,$258.05 ,$137.65 ,$111.16 ,$200.88 ,$137.65 ,$228.28 ,$137.65 ,$200.84 ,$137.65 ,$261.53 ,$325.54 ,$344.11 ,$137.65 ,$337.45 ,$357.30 ,$137.65 ,$297.75 ,$277.90 ,$293.78 ,$293.78 ,$344.11 ,$337.45 ,$137.65 ,$137.65 ,$278.30 ,$137.65 ,$165.15 , N/A ,$337.45 ,$295.94 ,$111.16 ,$357.30 ,$397.00 ,$137.65 ,$258.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),74000006,95810,HC SLEEP STUDY,740,1 ,"$4,642.00 ","$3,017.30 ",$907.02 ,"$4,642.00 ","$3,017.30 ",$907.02 ,"$1,299.76 ","$2,348.85 ",$907.02 ,"$2,669.15 ",$907.02 ,"$2,348.39 ",$907.02 ,"$1,723.35 ","$3,806.44 ","$2,267.56 ",$907.02 ,"$3,945.70 ","$4,177.80 ",$907.02 ,"$3,481.50 ","$3,249.40 ","$3,435.08 ","$3,435.08 ","$2,267.56 ","$3,945.70 ",$907.02 ,$907.02 ,"$3,254.04 ",$907.02 ,"$1,931.07 ", N/A ,"$3,945.70 ","$1,950.10 ","$1,299.76 ","$4,177.80 ","$2,508.00 ",$907.02 ,"$3,017.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$4,957.00 ","$3,222.05 ",$907.02 ,"$4,957.00 ","$3,222.05 ",$907.02 ,"$1,387.96 ","$2,508.24 ",$907.02 ,"$2,850.28 ",$907.02 ,"$2,507.75 ",$907.02 ,"$1,723.35 ","$4,064.74 ","$2,267.56 ",$907.02 ,"$4,213.45 ","$4,461.30 ",$907.02 ,"$3,717.75 ","$3,469.90 ","$3,668.18 ","$3,668.18 ","$2,267.56 ","$4,213.45 ",$907.02 ,$907.02 ,"$3,474.86 ",$907.02 ,"$2,062.11 ", N/A ,"$4,213.45 ","$1,950.10 ","$1,387.96 ","$4,461.30 ","$2,508.00 ",$907.02 ,"$3,222.05 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),74000035,G0399,HC SLEEP STUDY HOME ADULT,740,1 ,$928.00 ,$603.20 ,$137.65 ,$928.00 ,$603.20 ,$137.65 ,$259.84 ,$469.57 ,$137.65 ,$533.60 ,$137.65 ,$469.48 ,$137.65 ,$261.53 ,$760.96 ,$344.11 ,$137.65 ,$788.80 ,$835.20 ,$137.65 ,$696.00 ,$649.60 ,$686.72 ,$686.72 ,$344.11 ,$788.80 ,$137.65 ,$137.65 ,$650.53 ,$137.65 ,$386.05 , N/A ,$788.80 ,$295.94 ,$259.84 ,$835.20 ,$850.00 ,$137.65 ,$603.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001071,N/A,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001072,N/A,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$2,429.00 ","$1,578.85 ",$680.12 ,"$2,429.00 ","$1,578.85 ", N/A ,$680.12 ,"$1,229.07 ", N/A ,"$1,396.68 ", N/A ,"$1,228.83 ", N/A , N/A ,"$1,991.78 ", N/A , N/A ,"$2,064.65 ","$2,186.10 ", N/A ,"$1,821.75 ","$1,700.30 ","$1,797.46 ","$1,797.46 ", N/A ,"$2,064.65 ", N/A , N/A ,"$1,702.73 ", N/A ,"$1,010.46 ", N/A ,"$2,064.65 ", N/A ,$680.12 ,"$2,186.10 ", N/A , N/A ,"$1,578.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001073,N/A,HC EGD W/SUBMUCOSAL INJ - 43236,750,1 ,"$2,429.00 ","$1,578.85 ",$680.12 ,"$2,429.00 ","$1,578.85 ", N/A ,$680.12 ,"$1,229.07 ", N/A ,"$1,396.68 ", N/A ,"$1,228.83 ", N/A , N/A ,"$1,991.78 ", N/A , N/A ,"$2,064.65 ","$2,186.10 ", N/A ,"$1,821.75 ","$1,700.30 ","$1,797.46 ","$1,797.46 ", N/A ,"$2,064.65 ", N/A , N/A ,"$1,702.73 ", N/A ,"$1,010.46 ", N/A ,"$2,064.65 ", N/A ,$680.12 ,"$2,186.10 ", N/A , N/A ,"$1,578.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001075,N/A,HC EGD W/US FINE NEEDLE ASPIRATION LIMITED - 43238,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,429.00 ","$1,578.85 ",$680.12 ,"$2,429.00 ","$1,578.85 ", N/A ,$680.12 ,"$1,229.07 ", N/A ,"$1,396.68 ", N/A ,"$1,228.83 ", N/A , N/A ,"$1,991.78 ", N/A , N/A ,"$2,064.65 ","$2,186.10 ", N/A ,"$1,821.75 ","$1,700.30 ","$1,797.46 ","$1,797.46 ", N/A ,"$2,064.65 ", N/A , N/A ,"$1,702.73 ", N/A ,"$1,010.46 ", N/A ,"$2,064.65 ", N/A ,$680.12 ,"$2,186.10 ", N/A , N/A ,"$1,578.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001077,N/A,HC EGD W/TRANSMURAL DRAIN CYST - 43240,750,1 ,"$8,773.00 ","$5,702.45 ","$2,456.44 ","$8,773.00 ","$5,702.45 ", N/A ,"$2,456.44 ","$4,439.14 ", N/A ,"$5,044.48 ", N/A ,"$4,438.26 ", N/A , N/A ,"$7,193.86 ", N/A , N/A ,"$7,457.05 ","$7,895.70 ", N/A ,"$6,579.75 ","$6,141.10 ","$6,492.02 ","$6,492.02 ", N/A ,"$7,457.05 ", N/A , N/A ,"$6,149.87 ", N/A ,"$3,649.57 ", N/A ,"$7,457.05 ", N/A ,"$2,456.44 ","$7,895.70 ", N/A , N/A ,"$5,702.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001078,N/A,HC EGD W/US FINE NEEDLE ASPIRATION - 43242,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001079,N/A,HC EGD W/SCLEROTHERAPY - 43243,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001080,N/A,HC EGD W/BAND LIGATION - 43244,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001081,N/A,HC EGD W/DILAT STRICTURE - 43245,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001083,N/A,HC EGD W/FB REMOVAL - 43247,750,1 ,"$2,429.00 ","$1,578.85 ",$680.12 ,"$2,429.00 ","$1,578.85 ", N/A ,$680.12 ,"$1,229.07 ", N/A ,"$1,396.68 ", N/A ,"$1,228.83 ", N/A , N/A ,"$1,991.78 ", N/A , N/A ,"$2,064.65 ","$2,186.10 ", N/A ,"$1,821.75 ","$1,700.30 ","$1,797.46 ","$1,797.46 ", N/A ,"$2,064.65 ", N/A , N/A ,"$1,702.73 ", N/A ,"$1,010.46 ", N/A ,"$2,064.65 ", N/A ,$680.12 ,"$2,186.10 ", N/A , N/A ,"$1,578.85 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001085,N/A,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001086,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001087,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001088,N/A,HC EGD W/TRANSMURAL INJ/MARKER - 43253,750,1 ,"$4,627.00 ","$3,007.55 ","$1,295.56 ","$4,627.00 ","$3,007.55 ", N/A ,"$1,295.56 ","$2,341.26 ", N/A ,"$2,660.53 ", N/A ,"$2,340.80 ", N/A , N/A ,"$3,794.14 ", N/A , N/A ,"$3,932.95 ","$4,164.30 ", N/A ,"$3,470.25 ","$3,238.90 ","$3,423.98 ","$3,423.98 ", N/A ,"$3,932.95 ", N/A , N/A ,"$3,243.53 ", N/A ,"$1,924.83 ", N/A ,"$3,932.95 ", N/A ,"$1,295.56 ","$4,164.30 ", N/A , N/A ,"$3,007.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001089,N/A,HC EGD W/ENDO MUCOSAL RESECTION - 43254,750,1 ,"$4,627.00 ","$3,007.55 ","$1,295.56 ","$4,627.00 ","$3,007.55 ", N/A ,"$1,295.56 ","$2,341.26 ", N/A ,"$2,660.53 ", N/A ,"$2,340.80 ", N/A , N/A ,"$3,794.14 ", N/A , N/A ,"$3,932.95 ","$4,164.30 ", N/A ,"$3,470.25 ","$3,238.90 ","$3,423.98 ","$3,423.98 ", N/A ,"$3,932.95 ", N/A , N/A ,"$3,243.53 ", N/A ,"$1,924.83 ", N/A ,"$3,932.95 ", N/A ,"$1,295.56 ","$4,164.30 ", N/A , N/A ,"$3,007.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001090,N/A,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001091,N/A,HC EGD W/US DUODENUM/JEJUNUM - 43259,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001092,N/A,HC EGD W/STENT PLACEMENT - 43266,750,1 ,"$15,086.00 ","$9,805.90 ","$4,224.08 ","$15,086.00 ","$9,805.90 ", N/A ,"$4,224.08 ","$7,633.52 ", N/A ,"$8,674.45 ", N/A ,"$7,632.01 ", N/A , N/A ,"$12,370.52 ", N/A , N/A ,"$12,823.10 ","$13,577.40 ", N/A ,"$11,314.50 ","$10,560.20 ","$11,163.64 ","$11,163.64 ", N/A ,"$12,823.10 ", N/A , N/A ,"$10,575.29 ", N/A ,"$6,275.78 ", N/A ,"$12,823.10 ", N/A ,"$4,224.08 ","$13,577.40 ", N/A , N/A ,"$9,805.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001093,N/A,HC EGD W/TUMOR ABLATION - 43270,750,1 ,"$4,875.00 ","$3,168.75 ","$1,365.00 ","$4,875.00 ","$3,168.75 ", N/A ,"$1,365.00 ","$2,466.75 ", N/A ,"$2,803.13 ", N/A ,"$2,466.26 ", N/A , N/A ,"$3,997.50 ", N/A , N/A ,"$4,143.75 ","$4,387.50 ", N/A ,"$3,656.25 ","$3,412.50 ","$3,607.50 ","$3,607.50 ", N/A ,"$4,143.75 ", N/A , N/A ,"$3,417.38 ", N/A ,"$2,028.00 ", N/A ,"$4,143.75 ", N/A ,"$1,365.00 ","$4,387.50 ", N/A , N/A ,"$3,168.75 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001094,N/A,HC ERCP W/BRUSH/WASH - 43260,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001095,N/A,HC ERCP W/BIOPSY SGL/MULT - 43261,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001097,N/A,HC ERCP W/SPHINCTER PRESSURE MEASUREMENT - 43263,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001098,N/A,HC ERCP W/STONE REMOVAL DUCT - 43264,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001099,N/A,HC ERCP W/LITHOTRIPSY - 43265,750,1 ,"$15,086.00 ","$9,805.90 ","$4,224.08 ","$15,086.00 ","$9,805.90 ", N/A ,"$4,224.08 ","$7,633.52 ", N/A ,"$8,674.45 ", N/A ,"$7,632.01 ", N/A , N/A ,"$12,370.52 ", N/A , N/A ,"$12,823.10 ","$13,577.40 ", N/A ,"$11,314.50 ","$10,560.20 ","$11,163.64 ","$11,163.64 ", N/A ,"$12,823.10 ", N/A , N/A ,"$10,575.29 ", N/A ,"$6,275.78 ", N/A ,"$12,823.10 ", N/A ,"$4,224.08 ","$13,577.40 ", N/A , N/A ,"$9,805.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001100,N/A,HC ERCP W/STENT PLACEMENT DUCT - 43274,750,1 ,"$15,086.00 ","$9,805.90 ","$4,224.08 ","$15,086.00 ","$9,805.90 ", N/A ,"$4,224.08 ","$7,633.52 ", N/A ,"$8,674.45 ", N/A ,"$7,632.01 ", N/A , N/A ,"$12,370.52 ", N/A , N/A ,"$12,823.10 ","$13,577.40 ", N/A ,"$11,314.50 ","$10,560.20 ","$11,163.64 ","$11,163.64 ", N/A ,"$12,823.10 ", N/A , N/A ,"$10,575.29 ", N/A ,"$6,275.78 ", N/A ,"$12,823.10 ", N/A ,"$4,224.08 ","$13,577.40 ", N/A , N/A ,"$9,805.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001101,N/A,HC ERCP W/FB OR STENT REMOVAL DUCT - 43275,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001102,N/A,HC ERCP W/REM/EXCHG STENT W/DILAT  AND  WIRE EA - 43276,750,1 ,"$15,086.00 ","$9,805.90 ","$4,224.08 ","$15,086.00 ","$9,805.90 ", N/A ,"$4,224.08 ","$7,633.52 ", N/A ,"$8,674.45 ", N/A ,"$7,632.01 ", N/A , N/A ,"$12,370.52 ", N/A , N/A ,"$12,823.10 ","$13,577.40 ", N/A ,"$11,314.50 ","$10,560.20 ","$11,163.64 ","$11,163.64 ", N/A ,"$12,823.10 ", N/A , N/A ,"$10,575.29 ", N/A ,"$6,275.78 ", N/A ,"$12,823.10 ", N/A ,"$4,224.08 ","$13,577.40 ", N/A , N/A ,"$9,805.90 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001103,N/A,HC ERCP W/BALL DILAT DUCT/AMPULLA EA -43277,750,1 ,"$9,242.00 ","$6,007.30 ","$2,587.76 ","$9,242.00 ","$6,007.30 ", N/A ,"$2,587.76 ","$4,676.45 ", N/A ,"$5,314.15 ", N/A ,"$4,675.53 ", N/A , N/A ,"$7,578.44 ", N/A , N/A ,"$7,855.70 ","$8,317.80 ", N/A ,"$6,931.50 ","$6,469.40 ","$6,839.08 ","$6,839.08 ", N/A ,"$7,855.70 ", N/A , N/A ,"$6,478.64 ", N/A ,"$3,844.67 ", N/A ,"$7,855.70 ", N/A ,"$2,587.76 ","$8,317.80 ", N/A , N/A ,"$6,007.30 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001104,N/A,HC ERCP W/TUMOR ABLATION W/DILAT  AND  WIRE - 43278,750,1 ,"$8,773.00 ","$5,702.45 ","$2,456.44 ","$8,773.00 ","$5,702.45 ", N/A ,"$2,456.44 ","$4,439.14 ", N/A ,"$5,044.48 ", N/A ,"$4,438.26 ", N/A , N/A ,"$7,193.86 ", N/A , N/A ,"$7,457.05 ","$7,895.70 ", N/A ,"$6,579.75 ","$6,141.10 ","$6,492.02 ","$6,492.02 ", N/A ,"$7,457.05 ", N/A , N/A ,"$6,149.87 ", N/A ,"$3,649.57 ", N/A ,"$7,457.05 ", N/A ,"$2,456.44 ","$7,895.70 ", N/A , N/A ,"$5,702.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001109,N/A,HC GASTROSTOMY TUBE PLACE OPEN - 43832,750,1 ,"$3,028.00 ","$1,968.20 ",$847.84 ,"$3,028.00 ","$1,968.20 ", N/A ,$847.84 ,"$1,532.17 ", N/A ,"$1,741.10 ", N/A ,"$1,531.87 ", N/A , N/A ,"$2,482.96 ", N/A , N/A ,"$2,573.80 ","$2,725.20 ", N/A ,"$2,271.00 ","$2,119.60 ","$2,240.72 ","$2,240.72 ", N/A ,"$2,573.80 ", N/A , N/A ,"$2,122.63 ", N/A ,"$1,259.65 ", N/A ,"$2,573.80 ", N/A ,$847.84 ,"$2,725.20 ", N/A , N/A ,"$1,968.20 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001125,N/A,HC COLONOSCOPY STOMA DX W/BRUSH/WASH - 44388,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001126,N/A,HC COLONOSCOPY STOMA W/BX SGL/MULT - 44389,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001127,N/A,HC COLONOSCOPY STOMA W/FB REMOVAL - 44390,750,1 ,"$2,260.00 ","$1,469.00 ",$632.80 ,"$2,260.00 ","$1,469.00 ", N/A ,$632.80 ,"$1,143.56 ", N/A ,"$1,299.50 ", N/A ,"$1,143.33 ", N/A , N/A ,"$1,853.20 ", N/A , N/A ,"$1,921.00 ","$2,034.00 ", N/A ,"$1,695.00 ","$1,582.00 ","$1,672.40 ","$1,672.40 ", N/A ,"$1,921.00 ", N/A , N/A ,"$1,584.26 ", N/A ,$940.16 , N/A ,"$1,921.00 ", N/A ,$632.80 ,"$2,034.00 ", N/A , N/A ,"$1,469.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001128,N/A,HC COLONOSCOPY STOMA W/CONTROL BLEEDING - 44391,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001130,N/A,HC COLONOSCOPY STOMA W/REM TUMOR SNARE TECH - 44394,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001131,N/A,HC COLONOSCOPY STOMA W/ABLATION  - 44401,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001132,N/A,HC COLONOSCOPY STOMA W/STENT PLACEMENT - 44402,750,1 ,"$14,319.00 ","$9,307.35 ","$4,009.32 ","$14,319.00 ","$9,307.35 ", N/A ,"$4,009.32 ","$7,245.41 ", N/A ,"$8,233.43 ", N/A ,"$7,243.98 ", N/A , N/A ,"$11,741.58 ", N/A , N/A ,"$12,171.15 ","$12,887.10 ", N/A ,"$10,739.25 ","$10,023.30 ","$10,596.06 ","$10,596.06 ", N/A ,"$12,171.15 ", N/A , N/A ,"$10,037.62 ", N/A ,"$5,956.70 ", N/A ,"$12,171.15 ", N/A ,"$4,009.32 ","$12,887.10 ", N/A , N/A ,"$9,307.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001133,N/A,HC COLONOSCOPY STOMA W/MUCOSAL RESECTION - 44403,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001134,N/A,HC COLONOSCOPY STOMA W/SUBMUCOSAL INJ - 44404,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001135,N/A,HC COLONOSCOPY STOMA W/ENDO US LIMITED - 44406,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001136,N/A,HC COLONOSCOPY STOMA W/US GUID NEEDLE ASP - 44407,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001137,N/A,HC COLONOSCOPY STOMA W/DECOMPRESSION - 44408,750,1 ,"$2,260.00 ","$1,469.00 ",$632.80 ,"$2,260.00 ","$1,469.00 ", N/A ,$632.80 ,"$1,143.56 ", N/A ,"$1,299.50 ", N/A ,"$1,143.33 ", N/A , N/A ,"$1,853.20 ", N/A , N/A ,"$1,921.00 ","$2,034.00 ", N/A ,"$1,695.00 ","$1,582.00 ","$1,672.40 ","$1,672.40 ", N/A ,"$1,921.00 ", N/A , N/A ,"$1,584.26 ", N/A ,$940.16 , N/A ,"$1,921.00 ", N/A ,$632.80 ,"$2,034.00 ", N/A , N/A ,"$1,469.00 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001142,N/A,HC SIGMOIDOSCOPY DX W/BRUSH/WASH - 45330,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001143,N/A,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001144,N/A,HC SIGMOIDOSCOPY W/FB REMOVAL -45332,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001145,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN  HOT BIOPSY -45333,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001146,N/A,HC SIGMOIDOSCOPY W/CONTROL BLEEDING - 45334,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001147,N/A,HC SIGMOIDOSCOPY W/SUBMUCOSAL INJ - 45335,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001148,N/A,HC SIGMOIDOSCOPY W/DECOMPRESSION -45337,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001149,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001150,N/A,HC SIGMOIDOSCOPY W/DILATION - 45340,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001153,N/A,HC SIGMOIDOSCOPY W/ABLATION TUMOR - 45346,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001155,N/A,HC SIGMOIDOSCOPY W/ENDO MUCOSAL RESECTION - 45349,750,1 ,"$7,330.00 ","$4,764.50 ","$2,052.40 ","$7,330.00 ","$4,764.50 ", N/A ,"$2,052.40 ","$3,708.98 ", N/A ,"$4,214.75 ", N/A ,"$3,708.25 ", N/A , N/A ,"$6,010.60 ", N/A , N/A ,"$6,230.50 ","$6,597.00 ", N/A ,"$5,497.50 ","$5,131.00 ","$5,424.20 ","$5,424.20 ", N/A ,"$6,230.50 ", N/A , N/A ,"$5,138.33 ", N/A ,"$3,049.28 ", N/A ,"$6,230.50 ", N/A ,"$2,052.40 ","$6,597.00 ", N/A , N/A ,"$4,764.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001156,N/A,HC SIGMOIDOSCOPY W/BAND LIGATION - 45350,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001157,N/A,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ", N/A ,$666.68 ,"$1,204.79 ", N/A ,"$1,369.08 ", N/A ,"$1,204.55 ", N/A , N/A ,"$1,952.42 ", N/A , N/A ,"$2,023.85 ","$2,142.90 ", N/A ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ", N/A ,"$2,023.85 ", N/A , N/A ,"$1,669.08 ", N/A ,$990.50 , N/A ,"$2,023.85 ", N/A ,$666.68 ,"$2,142.90 ", N/A , N/A ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001158,N/A,HC COLONOSCOPY W/FB REMOVAL - 45379,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001159,N/A,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001160,N/A,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001161,N/A,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001162,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001163,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001164,N/A,HC COLONOSCOPY W/BALLOON DILATION - 45386,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001165,N/A,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001166,N/A,HC COLONOSCOPY W/STENT PLACEMENT - 45389,750,1 ,"$14,319.00 ","$9,307.35 ","$4,009.32 ","$14,319.00 ","$9,307.35 ", N/A ,"$4,009.32 ","$7,245.41 ", N/A ,"$8,233.43 ", N/A ,"$7,243.98 ", N/A , N/A ,"$11,741.58 ", N/A , N/A ,"$12,171.15 ","$12,887.10 ", N/A ,"$10,739.25 ","$10,023.30 ","$10,596.06 ","$10,596.06 ", N/A ,"$12,171.15 ", N/A , N/A ,"$10,037.62 ", N/A ,"$5,956.70 ", N/A ,"$12,171.15 ", N/A ,"$4,009.32 ","$12,887.10 ", N/A , N/A ,"$9,307.35 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001167,N/A,HC COLONOSCOPY W/MUCOSAL RESECTION - 45390,750,1 ,"$7,330.00 ","$4,764.50 ","$2,052.40 ","$7,330.00 ","$4,764.50 ", N/A ,"$2,052.40 ","$3,708.98 ", N/A ,"$4,214.75 ", N/A ,"$3,708.25 ", N/A , N/A ,"$6,010.60 ", N/A , N/A ,"$6,230.50 ","$6,597.00 ", N/A ,"$5,497.50 ","$5,131.00 ","$5,424.20 ","$5,424.20 ", N/A ,"$6,230.50 ", N/A , N/A ,"$5,138.33 ", N/A ,"$3,049.28 ", N/A ,"$6,230.50 ", N/A ,"$2,052.40 ","$6,597.00 ", N/A , N/A ,"$4,764.50 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001168,N/A,HC COLONOSCOPY W/ENDO US LIMITED -45391,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001169,N/A,HC COLONOSCOPY W/NEEDLE BIOPSY W/US EXAM - 45392,750,1 ,"$2,953.00 ","$1,919.45 ",$826.84 ,"$2,953.00 ","$1,919.45 ", N/A ,$826.84 ,"$1,494.22 ", N/A ,"$1,697.98 ", N/A ,"$1,493.92 ", N/A , N/A ,"$2,421.46 ", N/A , N/A ,"$2,510.05 ","$2,657.70 ", N/A ,"$2,214.75 ","$2,067.10 ","$2,185.22 ","$2,185.22 ", N/A ,"$2,510.05 ", N/A , N/A ,"$2,070.05 ", N/A ,"$1,228.45 ", N/A ,"$2,510.05 ", N/A ,$826.84 ,"$2,657.70 ", N/A , N/A ,"$1,919.45 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001171,N/A,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$3,111.00 ","$2,022.15 ",$871.08 ,"$3,111.00 ","$2,022.15 ", N/A ,$871.08 ,"$1,574.17 ", N/A ,"$1,788.83 ", N/A ,"$1,573.85 ", N/A , N/A ,"$2,551.02 ", N/A , N/A ,"$2,644.35 ","$2,799.90 ", N/A ,"$2,333.25 ","$2,177.70 ","$2,302.14 ","$2,302.14 ", N/A ,"$2,644.35 ", N/A , N/A ,"$2,180.81 ", N/A ,"$1,294.18 ", N/A ,"$2,644.35 ", N/A ,$871.08 ,"$2,799.90 ", N/A , N/A ,"$2,022.15 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001174,N/A,HC ANOSCOPY DX W/SPECIMEN -46600,750,1 ,$336.00 ,$218.40 ,$94.08 ,$336.00 ,$218.40 , N/A ,$94.08 ,$170.02 , N/A ,$193.20 , N/A ,$169.98 , N/A , N/A ,$275.52 , N/A , N/A ,$285.60 ,$302.40 , N/A ,$252.00 ,$235.20 ,$248.64 ,$248.64 , N/A ,$285.60 , N/A , N/A ,$235.54 , N/A ,$139.78 , N/A ,$285.60 , N/A ,$94.08 ,$302.40 , N/A , N/A ,$218.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),75001200,G0104,HC COLONOSCOPY SCREEN W/FLEX SIGMOID - G0104,750,1 ,"$2,381.00 ","$1,547.65 ",$666.68 ,"$2,381.00 ","$1,547.65 ",$782.37 ,$666.68 ,"$1,204.79 ",$782.37 ,"$1,369.08 ",$782.37 ,"$1,204.55 ",$782.37 ,"$1,486.51 ","$1,952.42 ","$1,955.93 ",$782.37 ,"$2,023.85 ","$2,142.90 ",$782.37 ,"$1,785.75 ","$1,666.70 ","$1,761.94 ","$1,761.94 ","$1,955.93 ","$2,023.85 ",$782.37 ,$782.37 ,"$1,669.08 ",$782.37 ,$990.50 , N/A ,"$2,023.85 ","$1,682.10 ",$666.68 ,"$2,142.90 ","$1,750.00 ",$782.37 ,"$1,547.65 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,807.00 ","$1,174.55 ",$505.96 ,"$1,807.00 ","$1,174.55 ",$626.03 ,$505.96 ,$914.34 ,$626.03 ,"$1,039.03 ",$626.03 ,$914.16 ,$626.03 ,"$1,189.46 ","$1,481.74 ","$1,565.07 ",$626.03 ,"$1,535.95 ","$1,626.30 ",$626.03 ,"$1,355.25 ","$1,264.90 ","$1,337.18 ","$1,337.18 ","$1,565.07 ","$1,535.95 ",$626.03 ,$626.03 ,"$1,266.71 ",$626.03 ,$751.71 , N/A ,"$1,535.95 ","$1,345.96 ",$505.96 ,"$1,626.30 ",$954.10 ,$626.03 ,"$1,174.55 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$146.00 ,$94.90 ,$40.88 ,$146.00 ,$94.90 , N/A ,$40.88 ,$73.88 , N/A ,$83.95 , N/A ,$73.86 , N/A , N/A ,$119.72 , N/A , N/A ,$124.10 ,$131.40 , N/A ,$109.50 ,$102.20 ,$108.04 ,$108.04 , N/A ,$124.10 , N/A , N/A ,$102.35 , N/A ,$60.74 , N/A ,$124.10 , N/A ,$40.88 ,$131.40 ,$146.00 , N/A ,$94.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$65.00 ,$42.25 ,$18.20 ,$65.00 ,$42.25 , N/A ,$18.20 ,$32.89 , N/A ,$37.38 , N/A ,$32.88 , N/A , N/A ,$53.30 , N/A , N/A ,$55.25 ,$58.50 , N/A ,$48.75 ,$45.50 ,$48.10 ,$48.10 , N/A ,$55.25 , N/A , N/A ,$45.57 , N/A ,$27.04 , N/A ,$55.25 , N/A ,$18.20 ,$58.50 ,$65.00 , N/A ,$42.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),76200022,G0378,HC OBSERVATION W/TELEMETRY PER HR,762,1 ,$65.00 ,$42.25 ,$18.20 ,$65.00 ,$42.25 , N/A ,$18.20 ,$32.89 , N/A ,$37.38 , N/A ,$32.88 , N/A , N/A ,$53.30 , N/A , N/A ,$55.25 ,$58.50 , N/A ,$48.75 ,$45.50 ,$48.10 ,$48.10 , N/A ,$55.25 , N/A , N/A ,$45.57 , N/A ,$27.04 , N/A ,$55.25 , N/A ,$18.20 ,$58.50 ,$65.00 , N/A ,$42.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$97.00 ,$63.05 ,$27.16 ,$152.81 ,$63.05 ,$61.12 ,$27.16 ,$49.08 ,$61.12 ,$55.78 ,$61.12 ,$49.07 ,$61.12 ,$97.00 ,$79.54 ,$152.81 ,$61.12 ,$82.45 ,$87.30 ,$61.12 ,$72.75 ,$67.90 ,$71.78 ,$71.78 ,$97.00 ,$82.45 ,$61.12 ,$61.12 ,$68.00 ,$61.12 ,$40.35 , N/A ,$82.45 ,$131.42 ,$27.16 ,$87.30 ,$75.00 ,$61.12 ,$63.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$26.00 ,$16.90 ,$7.28 ,$98.63 ,$16.90 ,$39.45 ,$7.28 ,$13.16 ,$39.45 ,$14.95 ,$26.00 ,$13.15 ,$26.00 ,$26.00 ,$21.32 ,$98.63 ,$39.45 ,$22.10 ,$23.40 ,$39.45 ,$19.50 ,$18.20 ,$19.24 ,$19.24 ,$26.00 ,$22.10 ,$39.45 ,$39.45 ,$18.23 ,$39.45 ,$10.82 , N/A ,$22.10 ,$84.82 ,$7.28 ,$23.40 ,$26.00 ,$39.45 ,$16.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$112.00 ,$72.80 ,$31.36 ,$112.00 ,$72.80 ,$39.45 ,$31.36 ,$56.67 ,$39.45 ,$64.40 ,$39.45 ,$56.66 ,$39.45 ,$74.96 ,$91.84 ,$98.63 ,$39.45 ,$95.20 ,$100.80 ,$39.45 ,$84.00 ,$78.40 ,$82.88 ,$82.88 ,$98.63 ,$95.20 ,$39.45 ,$39.45 ,$78.51 ,$39.45 ,$46.59 , N/A ,$95.20 ,$84.82 ,$31.36 ,$100.80 ,$75.00 ,$39.45 ,$72.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$48.00 ,$31.20 ,$13.44 ,$98.63 ,$31.20 ,$39.45 ,$13.44 ,$24.29 ,$39.45 ,$27.60 ,$39.45 ,$24.28 ,$39.45 ,$48.00 ,$39.36 ,$98.63 ,$39.45 ,$40.80 ,$43.20 ,$39.45 ,$36.00 ,$33.60 ,$35.52 ,$35.52 ,$48.00 ,$40.80 ,$39.45 ,$39.45 ,$33.65 ,$39.45 ,$19.97 , N/A ,$40.80 ,$84.82 ,$13.44 ,$43.20 ,$48.00 ,$39.45 ,$31.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000003,97110,HC THERA EXER; EA 15 MIN - 95,780,1 ,$116.00 ,$75.40 ,$29.76 ,$116.00 ,$75.40 ,$29.76 ,$32.48 ,$58.70 ,$29.76 ,$66.70 ,$29.76 ,$58.68 ,$29.76 ,$56.54 ,$95.12 ,$74.40 ,$29.76 ,$98.60 ,$104.40 ,$29.76 ,$87.00 ,$81.20 ,$85.84 ,$85.84 ,$74.40 ,$98.60 ,$29.76 ,$29.76 ,$81.32 ,$29.76 ,$48.26 , N/A ,$98.60 ,$63.98 ,$32.48 ,$104.40 ,$61.25 ,$29.76 ,$75.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000004,97112,HC NEUROMUSCULAR RE ED EA 15 MIN - 95,780,1 ,$106.00 ,$68.90 ,$29.68 ,$106.00 ,$68.90 ,$34.43 ,$29.68 ,$53.64 ,$34.43 ,$60.95 ,$34.43 ,$53.63 ,$34.43 ,$65.42 ,$86.92 ,$86.08 ,$34.43 ,$90.10 ,$95.40 ,$34.43 ,$79.50 ,$74.20 ,$78.44 ,$78.44 ,$86.08 ,$90.10 ,$34.43 ,$34.43 ,$74.31 ,$34.43 ,$44.10 , N/A ,$90.10 ,$74.02 ,$29.68 ,$95.40 ,$55.97 ,$34.43 ,$68.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000005,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN - 95,780,1 ,$130.00 ,$84.50 ,$36.40 ,$130.00 ,$84.50 ,$37.24 ,$36.40 ,$65.78 ,$37.24 ,$74.75 ,$37.24 ,$65.77 ,$37.24 ,$70.76 ,$106.60 ,$93.10 ,$37.24 ,$110.50 ,$117.00 ,$37.24 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$93.10 ,$110.50 ,$37.24 ,$37.24 ,$91.13 ,$37.24 ,$54.08 , N/A ,$110.50 ,$80.07 ,$36.40 ,$117.00 ,$68.64 ,$37.24 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000006,97535,HC SELF CARE ADL TRAINING EA 15 MIN - 95,780,1 ,$130.00 ,$84.50 ,$33.02 ,$130.00 ,$84.50 ,$33.02 ,$36.40 ,$65.78 ,$33.02 ,$74.75 ,$33.02 ,$65.77 ,$33.02 ,$62.74 ,$106.60 ,$82.55 ,$33.02 ,$110.50 ,$117.00 ,$33.02 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$82.55 ,$110.50 ,$33.02 ,$33.02 ,$91.13 ,$33.02 ,$54.08 , N/A ,$110.50 ,$70.99 ,$36.40 ,$117.00 ,$68.64 ,$33.02 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000007,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN - 95,780,1 ,$138.00 ,$89.70 ,$23.34 ,$138.00 ,$89.70 ,$23.34 ,$38.64 ,$69.83 ,$23.34 ,$79.35 ,$23.34 ,$69.81 ,$23.34 ,$44.35 ,$113.16 ,$58.35 ,$23.34 ,$117.30 ,$124.20 ,$23.34 ,$103.50 ,$96.60 ,$102.12 ,$102.12 ,$58.35 ,$117.30 ,$23.34 ,$23.34 ,$96.74 ,$23.34 ,$57.41 , N/A ,$117.30 ,$50.18 ,$38.64 ,$124.20 ,$72.86 ,$23.34 ,$89.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000008,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN - 95,780,1 ,$130.00 ,$84.50 ,$22.65 ,$130.00 ,$84.50 ,$22.65 ,$36.40 ,$65.78 ,$22.65 ,$74.75 ,$22.65 ,$65.77 ,$22.65 ,$43.04 ,$106.60 ,$56.63 ,$22.65 ,$110.50 ,$117.00 ,$22.65 ,$97.50 ,$91.00 ,$96.20 ,$96.20 ,$56.63 ,$110.50 ,$22.65 ,$22.65 ,$91.13 ,$22.65 ,$54.08 , N/A ,$110.50 ,$48.70 ,$36.40 ,$117.00 ,$68.64 ,$22.65 ,$84.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000009,97161,HC PT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$291.00 ,$189.15 ,$81.48 ,$291.00 ,$189.15 ,$101.33 ,$81.48 ,$147.25 ,$101.33 ,$167.33 ,$101.33 ,$147.22 ,$101.33 ,$192.53 ,$238.62 ,$253.33 ,$101.33 ,$247.35 ,$261.90 ,$101.33 ,$218.25 ,$203.70 ,$215.34 ,$215.34 ,$253.33 ,$247.35 ,$101.33 ,$101.33 ,$203.99 ,$101.33 ,$121.06 , N/A ,$247.35 ,$217.86 ,$81.48 ,$261.90 ,$153.65 ,$101.33 ,$189.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000010,97162,HC PT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$583.00 ,$378.95 ,$101.33 ,$583.00 ,$378.95 ,$101.33 ,$163.24 ,$295.00 ,$101.33 ,$335.23 ,$101.33 ,$294.94 ,$101.33 ,$192.53 ,$478.06 ,$253.33 ,$101.33 ,$495.55 ,$524.70 ,$101.33 ,$437.25 ,$408.10 ,$431.42 ,$431.42 ,$253.33 ,$495.55 ,$101.33 ,$101.33 ,$408.68 ,$101.33 ,$242.53 , N/A ,$495.55 ,$217.86 ,$163.24 ,$524.70 ,$307.82 ,$101.33 ,$378.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000011,97163,HC PT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$874.00 ,$568.10 ,$101.33 ,$874.00 ,$568.10 ,$101.33 ,$244.72 ,$442.24 ,$101.33 ,$502.55 ,$101.33 ,$442.16 ,$101.33 ,$192.53 ,$716.68 ,$253.33 ,$101.33 ,$742.90 ,$786.60 ,$101.33 ,$655.50 ,$611.80 ,$646.76 ,$646.76 ,$253.33 ,$742.90 ,$101.33 ,$101.33 ,$612.67 ,$101.33 ,$363.58 , N/A ,$742.90 ,$217.86 ,$244.72 ,$786.60 ,$461.47 ,$101.33 ,$568.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000012,97164,HC PT RE-EVAL 15 MIN - 95,780,1 ,$224.00 ,$145.60 ,$62.72 ,$224.00 ,$145.60 ,$69.42 ,$62.72 ,$113.34 ,$69.42 ,$128.80 ,$69.42 ,$113.32 ,$69.42 ,$131.90 ,$183.68 ,$173.55 ,$69.42 ,$190.40 ,$201.60 ,$69.42 ,$168.00 ,$156.80 ,$165.76 ,$165.76 ,$173.55 ,$190.40 ,$69.42 ,$69.42 ,$157.02 ,$69.42 ,$93.18 , N/A ,$190.40 ,$149.25 ,$62.72 ,$201.60 ,$118.27 ,$69.42 ,$145.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000013,97165,HC OT EVAL LOW COMPLEXITY 30 MIN - 95,780,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$167.90 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000014,97116,HC AMBULATION GAIT TRAIN EA 15 MIN - 95,780,1 ,$108.00 ,$70.20 ,$29.76 ,$108.00 ,$70.20 ,$29.76 ,$30.24 ,$54.65 ,$29.76 ,$62.10 ,$29.76 ,$54.64 ,$29.76 ,$56.54 ,$88.56 ,$74.40 ,$29.76 ,$91.80 ,$97.20 ,$29.76 ,$81.00 ,$75.60 ,$79.92 ,$79.92 ,$74.40 ,$91.80 ,$29.76 ,$29.76 ,$75.71 ,$29.76 ,$44.93 , N/A ,$91.80 ,$63.98 ,$30.24 ,$97.20 ,$57.02 ,$29.76 ,$70.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000015,97167,HC OT EVAL HIGH COMPLEXITY 60 MIN - 95,780,1 ,$927.00 ,$602.55 ,$101.98 ,$927.00 ,$602.55 ,$101.98 ,$259.56 ,$469.06 ,$101.98 ,$533.03 ,$101.98 ,$468.97 ,$101.98 ,$193.76 ,$760.14 ,$254.95 ,$101.98 ,$787.95 ,$834.30 ,$101.98 ,$695.25 ,$648.90 ,$685.98 ,$685.98 ,$254.95 ,$787.95 ,$101.98 ,$101.98 ,$649.83 ,$101.98 ,$385.63 , N/A ,$787.95 ,$219.26 ,$259.56 ,$834.30 ,$489.46 ,$101.98 ,$602.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000016,97168,HC OT RE-EVAL 30 MIN - 95,780,1 ,$184.00 ,$119.60 ,$51.52 ,$184.00 ,$119.60 ,$69.75 ,$51.52 ,$93.10 ,$69.75 ,$105.80 ,$69.75 ,$93.09 ,$69.75 ,$132.53 ,$150.88 ,$174.38 ,$69.75 ,$156.40 ,$165.60 ,$69.75 ,$138.00 ,$128.80 ,$136.16 ,$136.16 ,$174.38 ,$156.40 ,$69.75 ,$69.75 ,$128.98 ,$69.75 ,$76.54 , N/A ,$156.40 ,$149.96 ,$51.52 ,$165.60 ,$97.15 ,$69.75 ,$119.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000017,92507,HC SPEECH THERAPY TREATMENT 15 MIN - 95,780,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$144.67 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000018,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN - 95,780,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$98.21 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000019,92526,HC DYSPHAGIA TREATMENT 15 MIN - 95,780,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$127.25 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000198,92526,PC DYSPHAGIA TREATMENT 30 MIN - 95,780,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$127.25 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000199,92526,PC DYSPHAGIA TREATMENT 45 MIN - 95,780,1 ,$241.00 ,$156.65 ,$67.48 ,$241.00 ,$156.65 ,$85.76 ,$67.48 ,$121.95 ,$85.76 ,$138.58 ,$85.76 ,$121.92 ,$85.76 ,$162.94 ,$197.62 ,$214.40 ,$85.76 ,$204.85 ,$216.90 ,$85.76 ,$180.75 ,$168.70 ,$178.34 ,$178.34 ,$214.40 ,$204.85 ,$85.76 ,$85.76 ,$168.94 ,$85.76 ,$100.26 , N/A ,$204.85 ,$184.38 ,$67.48 ,$216.90 ,$127.25 ,$85.76 ,$156.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000201,92507,HC SPEECH THERAPY TREATMENT 30 MIN - 95,780,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$144.67 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000202,92507,PC SPEECH THERAPY TREATMENT 45 MIN - 95,780,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$144.67 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000203,92507,PC SPEECH THERAPY TREATMENT 60 MIN - 95,780,1 ,$274.00 ,$178.10 ,$76.72 ,$274.00 ,$178.10 ,$77.53 ,$76.72 ,$138.64 ,$77.53 ,$157.55 ,$77.53 ,$138.62 ,$77.53 ,$147.31 ,$224.68 ,$193.83 ,$77.53 ,$232.90 ,$246.60 ,$77.53 ,$205.50 ,$191.80 ,$202.76 ,$202.76 ,$193.83 ,$232.90 ,$77.53 ,$77.53 ,$192.07 ,$77.53 ,$113.98 , N/A ,$232.90 ,$166.69 ,$76.72 ,$246.60 ,$144.67 ,$77.53 ,$178.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000204,92521,PC EVALUATION OF SPEECH FLUENCY 30 MIN - 95,780,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$98.21 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000205,92521,PC EVALUATION OF SPEECH FLUENCY 45 MIN - 95,780,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$98.21 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000206,92521,PC EVALUATION OF SPEECH FLUENCY 60 MIN - 95,780,1 ,$186.00 ,$120.90 ,$52.08 ,$336.30 ,$120.90 ,$134.52 ,$52.08 ,$94.12 ,$134.52 ,$106.95 ,$134.52 ,$94.10 ,$134.52 ,$186.00 ,$152.52 ,$336.30 ,$134.52 ,$158.10 ,$167.40 ,$134.52 ,$139.50 ,$130.20 ,$137.64 ,$137.64 ,$186.00 ,$158.10 ,$134.52 ,$134.52 ,$130.39 ,$134.52 ,$77.38 , N/A ,$158.10 ,$289.22 ,$52.08 ,$167.40 ,$98.21 ,$134.52 ,$120.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000207,97165,PC OT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$167.90 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000208,97165,PC OT EVAL LOW COMPLEXITY 45 MIN - 95,780,1 ,$318.00 ,$206.70 ,$89.04 ,$318.00 ,$206.70 ,$101.98 ,$89.04 ,$160.91 ,$101.98 ,$182.85 ,$101.98 ,$160.88 ,$101.98 ,$193.76 ,$260.76 ,$254.95 ,$101.98 ,$270.30 ,$286.20 ,$101.98 ,$238.50 ,$222.60 ,$235.32 ,$235.32 ,$254.95 ,$270.30 ,$101.98 ,$101.98 ,$222.92 ,$101.98 ,$132.29 , N/A ,$270.30 ,$219.26 ,$89.04 ,$286.20 ,$167.90 ,$101.98 ,$206.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),78000211,97166,HC OT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$637.00 ,$414.05 ,$101.98 ,$637.00 ,$414.05 ,$101.98 ,$178.36 ,$322.32 ,$101.98 ,$366.28 ,$101.98 ,$322.26 ,$101.98 ,$193.76 ,$522.34 ,$254.95 ,$101.98 ,$541.45 ,$573.30 ,$101.98 ,$477.75 ,$445.90 ,$471.38 ,$471.38 ,$254.95 ,$541.45 ,$101.98 ,$101.98 ,$446.54 ,$101.98 ,$264.99 , N/A ,$541.45 ,$219.26 ,$178.36 ,$573.30 ,$336.34 ,$101.98 ,$414.05 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,$996.00 ,$647.40 ,$226.85 ,$996.00 ,$647.40 ,$226.85 ,$278.88 ,$503.98 ,$226.85 ,$572.70 ,$226.85 ,$503.88 ,$226.85 ,$431.02 ,$816.72 ,$567.13 ,$226.85 ,$846.60 ,$896.40 ,$226.85 ,$747.00 ,$697.20 ,$737.04 ,$737.04 ,$567.13 ,$846.60 ,$226.85 ,$226.85 ,$698.20 ,$226.85 ,$414.34 , N/A ,$846.60 ,$487.73 ,$278.88 ,$896.40 ,$525.89 ,$226.85 ,$647.40 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$163.68 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$574.00 ,$373.10 ,$111.17 ,$574.00 ,$373.10 ,$111.17 ,$160.72 ,$290.44 ,$111.17 ,$330.05 ,$111.17 ,$290.39 ,$111.17 ,$211.22 ,$470.68 ,$277.92 ,$111.17 ,$487.90 ,$516.60 ,$111.17 ,$430.50 ,$401.80 ,$424.76 ,$424.76 ,$277.92 ,$487.90 ,$111.17 ,$111.17 ,$402.37 ,$111.17 ,$238.78 , N/A ,$487.90 ,$239.01 ,$160.72 ,$516.60 ,$303.07 ,$111.17 ,$373.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100023,93923,HC TCPO2/ABI/PPG MULT LEVELS,921,1 ,"$1,190.00 ",$773.50 ,$137.65 ,"$1,190.00 ",$773.50 ,$137.65 ,$333.20 ,$602.14 ,$137.65 ,$684.25 ,$137.65 ,$602.02 ,$137.65 ,$261.53 ,$975.80 ,$344.11 ,$137.65 ,"$1,011.50 ","$1,071.00 ",$137.65 ,$892.50 ,$833.00 ,$880.60 ,$880.60 ,$344.11 ,"$1,011.50 ",$137.65 ,$137.65 ,$834.19 ,$137.65 ,$495.04 , N/A ,"$1,011.50 ",$295.94 ,$333.20 ,"$1,071.00 ",$628.32 ,$137.65 ,$773.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,190.00 ",$773.50 ,$137.65 ,"$1,190.00 ",$773.50 ,$137.65 ,$333.20 ,$602.14 ,$137.65 ,$684.25 ,$137.65 ,$602.02 ,$137.65 ,$261.53 ,$975.80 ,$344.11 ,$137.65 ,"$1,011.50 ","$1,071.00 ",$137.65 ,$892.50 ,$833.00 ,$880.60 ,$880.60 ,$344.11 ,"$1,011.50 ",$137.65 ,$137.65 ,$834.19 ,$137.65 ,$495.04 , N/A ,"$1,011.50 ",$295.94 ,$333.20 ,"$1,071.00 ",$628.32 ,$137.65 ,$773.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,"$1,190.00 ",$773.50 ,$137.65 ,"$1,190.00 ",$773.50 ,$137.65 ,$333.20 ,$602.14 ,$137.65 ,$684.25 ,$137.65 ,$602.02 ,$137.65 ,$261.53 ,$975.80 ,$344.11 ,$137.65 ,"$1,011.50 ","$1,071.00 ",$137.65 ,$892.50 ,$833.00 ,$880.60 ,$880.60 ,$344.11 ,"$1,011.50 ",$137.65 ,$137.65 ,$834.19 ,$137.65 ,$495.04 , N/A ,"$1,011.50 ",$295.94 ,$333.20 ,"$1,071.00 ",$628.32 ,$137.65 ,$773.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,$753.00 ,$489.45 ,$210.84 ,$753.00 ,$489.45 ,$260.92 ,$210.84 ,$381.02 ,$260.92 ,$432.98 ,$260.92 ,$380.94 ,$260.92 ,$495.74 ,$617.46 ,$652.29 ,$260.92 ,$640.05 ,$677.70 ,$260.92 ,$564.75 ,$527.10 ,$557.22 ,$557.22 ,$652.29 ,$640.05 ,$260.92 ,$260.92 ,$527.85 ,$260.92 ,$313.25 , N/A ,$640.05 ,$560.97 ,$210.84 ,$677.70 ,$397.58 ,$260.92 ,$489.45 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$1,556.00 ","$1,011.40 ",$226.85 ,"$1,556.00 ","$1,011.40 ",$226.85 ,$435.68 ,$787.34 ,$226.85 ,$894.70 ,$226.85 ,$787.18 ,$226.85 ,$431.02 ,"$1,275.92 ",$567.13 ,$226.85 ,"$1,322.60 ","$1,400.40 ",$226.85 ,"$1,167.00 ","$1,089.20 ","$1,151.44 ","$1,151.44 ",$567.13 ,"$1,322.60 ",$226.85 ,$226.85 ,"$1,090.76 ",$226.85 ,$647.30 , N/A ,"$1,322.60 ",$487.73 ,$435.68 ,"$1,400.40 ",$821.57 ,$226.85 ,"$1,011.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$163.68 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$1,414.00 ",$919.10 ,$226.85 ,"$1,414.00 ",$919.10 ,$226.85 ,$395.92 ,$715.48 ,$226.85 ,$813.05 ,$226.85 ,$715.34 ,$226.85 ,$431.02 ,"$1,159.48 ",$567.13 ,$226.85 ,"$1,201.90 ","$1,272.60 ",$226.85 ,"$1,060.50 ",$989.80 ,"$1,046.36 ","$1,046.36 ",$567.13 ,"$1,201.90 ",$226.85 ,$226.85 ,$991.21 ,$226.85 ,$588.22 , N/A ,"$1,201.90 ",$487.73 ,$395.92 ,"$1,272.60 ",$746.59 ,$226.85 ,$919.10 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$163.68 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100039,93931,HC DUPLEX ARTRL UPR EXT PSEUD ONLY,921,1 ,$310.00 ,$201.50 ,$86.80 ,$310.00 ,$201.50 ,$107.33 ,$86.80 ,$156.86 ,$107.33 ,$178.25 ,$107.33 ,$156.83 ,$107.33 ,$203.93 ,$254.20 ,$268.33 ,$107.33 ,$263.50 ,$279.00 ,$107.33 ,$232.50 ,$217.00 ,$229.40 ,$229.40 ,$268.33 ,$263.50 ,$107.33 ,$107.33 ,$217.31 ,$107.33 ,$128.96 , N/A ,$263.50 ,$230.77 ,$86.80 ,$279.00 ,$163.68 ,$107.33 ,$201.50 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,556.00 ","$1,011.40 ",$226.85 ,"$1,556.00 ","$1,011.40 ",$226.85 ,$435.68 ,$787.34 ,$226.85 ,$894.70 ,$226.85 ,$787.18 ,$226.85 ,$431.02 ,"$1,275.92 ",$567.13 ,$226.85 ,"$1,322.60 ","$1,400.40 ",$226.85 ,"$1,167.00 ","$1,089.20 ","$1,151.44 ","$1,151.44 ",$567.13 ,"$1,322.60 ",$226.85 ,$226.85 ,"$1,090.76 ",$226.85 ,$647.30 , N/A ,"$1,322.60 ",$487.73 ,$435.68 ,"$1,400.40 ",$821.57 ,$226.85 ,"$1,011.40 "
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,"$1,121.00 ",$728.65 ,$107.33 ,"$1,121.00 ",$728.65 ,$107.33 ,$313.88 ,$567.23 ,$107.33 ,$644.58 ,$107.33 ,$567.11 ,$107.33 ,$203.93 ,$919.22 ,$268.33 ,$107.33 ,$952.85 ,"$1,008.90 ",$107.33 ,$840.75 ,$784.70 ,$829.54 ,$829.54 ,$268.33 ,$952.85 ,$107.33 ,$107.33 ,$785.82 ,$107.33 ,$466.34 , N/A ,$952.85 ,$230.77 ,$313.88 ,"$1,008.90 ",$591.89 ,$107.33 ,$728.65 
HSHS HOLY FAMILY HOSPITAL INC (ACU),92100049,93923,HC RESTING ARTERIAL EXTREMITY COMP -52,921,1 ,"$1,226.00 ",$796.90 ,$68.82 ,"$1,226.00 ",$796.90 ,$68.82 ,$343.28 ,$620.36 ,$68.82 ,$704.95 ,$68.82 ,$620.23 ,$68.82 ,$130.76 ,"$1,005.32 ",$172.06 ,$68.82 ,"$1,042.10 ","$1,103.40 ",$68.82 ,$919.50 ,$858.20 ,$907.24 ,$907.24 ,$172.06 ,"$1,042.10 ",$68.82 ,$68.82 ,$859.43 ,$68.82 ,$510.02 , N/A ,"$1,042.10 ",$147.97 ,$343.28 ,"$1,103.40 ",$647.33 ,$68.82 ,$796.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94000104,96372,HC INJECTION IM/SUBQ,940,1 ,$132.00 ,$85.80 ,$36.96 ,$152.81 ,$85.80 ,$61.12 ,$36.96 ,$66.79 ,$61.12 ,$75.90 ,$61.12 ,$66.78 ,$61.12 ,$116.14 ,$108.24 ,$152.81 ,$61.12 ,$112.20 ,$118.80 ,$61.12 ,$99.00 ,$92.40 ,$97.68 ,$97.68 ,$132.00 ,$112.20 ,$61.12 ,$61.12 ,$92.53 ,$61.12 ,$54.91 , N/A ,$112.20 ,$131.42 ,$36.96 ,$118.80 ,$69.70 ,$61.12 ,$85.80 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94000105,96374,HC INJ IV PUSH SINGL/INITIAL,940,1 ,$285.00 ,$185.25 ,$79.80 ,$504.21 ,$185.25 ,$201.68 ,$79.80 ,$144.21 ,$201.68 ,$163.88 ,$201.68 ,$144.18 ,$201.68 ,$285.00 ,$233.70 ,$504.21 ,$201.68 ,$242.25 ,$256.50 ,$201.68 ,$213.75 ,$199.50 ,$210.90 ,$210.90 ,$285.00 ,$242.25 ,$201.68 ,$201.68 ,$199.79 ,$201.68 ,$118.56 , N/A ,$242.25 ,$433.62 ,$79.80 ,$256.50 ,$150.48 ,$201.68 ,$185.25 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94000114,20560,HC NEEDLE INSERTION W/O INJECTION 1-2 MUSCLES,940,1 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$0.01 ,$24.36 , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$24.36 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$24.36 ,$0.01 ,$24.36 , N/A , N/A ,$0.01 ,$52.36 , N/A ,$0.01 ,$0.01 ,$24.36 ,$0.01 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94000115,20561,HC NEEDLE INSERTION W/O INJECTION 3+ MUSCLES,940,1 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$0.01 ,$24.36 , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$24.36 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$24.36 ,$0.01 ,$24.36 , N/A , N/A ,$0.01 ,$52.36 , N/A ,$0.01 ,$0.01 ,$24.36 ,$0.01 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$47.00 ,$30.55 ,$13.16 ,$91.93 ,$30.55 ,$31.25 ,$13.16 ,$23.78 ,$31.25 ,$27.03 ,$31.25 ,$23.78 ,$31.25 ,$47.00 ,$38.54 ,$91.93 ,$31.25 ,$39.95 ,$42.30 ,$31.25 ,$35.25 ,$32.90 ,$34.78 ,$34.78 ,$31.25 ,$39.95 ,$31.25 ,$31.25 ,$32.95 ,$31.25 ,$19.55 , N/A ,$39.95 ,$79.06 ,$13.16 ,$42.30 ,$47.00 ,$31.25 ,$30.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94200006,97803,HC NUTRITION THRPY RE-EVAL 15 MIN,942,1 ,$47.00 ,$30.55 ,$13.16 ,$80.10 ,$30.55 ,$27.23 ,$13.16 ,$23.78 ,$27.23 ,$27.03 ,$27.23 ,$23.78 ,$27.23 ,$47.00 ,$38.54 ,$80.10 ,$27.23 ,$39.95 ,$42.30 ,$27.23 ,$35.25 ,$32.90 ,$34.78 ,$34.78 ,$27.23 ,$39.95 ,$27.23 ,$27.23 ,$32.95 ,$27.23 ,$19.55 , N/A ,$39.95 ,$68.89 ,$13.16 ,$42.30 ,$47.00 ,$27.23 ,$30.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$226.00 ,$146.90 ,$63.28 ,$286.10 ,$146.90 ,$114.44 ,$63.28 ,$114.36 ,$114.44 ,$129.95 ,$114.44 ,$114.33 ,$114.44 ,$217.43 ,$185.32 ,$286.10 ,$114.44 ,$192.10 ,$203.40 ,$114.44 ,$169.50 ,$158.20 ,$167.24 ,$167.24 ,$226.00 ,$192.10 ,$114.44 ,$114.44 ,$158.43 ,$114.44 ,$94.02 , N/A ,$192.10 ,$246.04 ,$63.28 ,$203.40 ,$160.00 ,$114.44 ,$146.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 ,$25.35 , N/A ,$10.92 ,$19.73 , N/A ,$22.43 , N/A ,$19.73 , N/A , N/A ,$31.98 , N/A , N/A ,$33.15 ,$35.10 , N/A ,$29.25 ,$27.30 ,$28.86 ,$28.86 , N/A ,$33.15 , N/A , N/A ,$27.34 , N/A ,$15.49 , N/A ,$33.15 , N/A ,$10.92 ,$35.10 , N/A , N/A ,$25.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$68.00 ,$44.20 ,$19.04 ,$68.00 ,$44.20 , N/A ,$19.04 ,$34.41 , N/A ,$39.10 , N/A ,$34.40 , N/A , N/A ,$55.76 , N/A , N/A ,$57.80 ,$61.20 , N/A ,$51.00 ,$47.60 ,$50.32 ,$50.32 , N/A ,$57.80 , N/A , N/A ,$47.67 , N/A ,$27.35 , N/A ,$57.80 , N/A ,$19.04 ,$61.20 , N/A , N/A ,$44.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$107.00 ,$69.55 ,$29.96 ,$107.00 ,$69.55 , N/A ,$29.96 ,$54.14 , N/A ,$61.53 , N/A ,$54.13 , N/A , N/A ,$87.74 , N/A , N/A ,$90.95 ,$96.30 , N/A ,$80.25 ,$74.90 ,$79.18 ,$79.18 , N/A ,$90.95 , N/A , N/A ,$75.01 , N/A ,$42.42 , N/A ,$90.95 , N/A ,$29.96 ,$96.30 , N/A , N/A ,$69.55 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400285,1996,PC ANESTH EPID/SUBAR DRUG ADMIN DAILY MGMT-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400289,142,PC ANESTH EYE LENS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400294,300,PC ANESTH HEAD/NECK/TRUNK NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400295,320,PC ANESTH NECK ORGANS >1YR NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400296,400,PC ANESTH INTEG EXTRM/TRUNK NOS-QZ,964,1 ,$195.68 ,$127.19 ,$54.79 ,$195.68 ,$127.19 , N/A ,$54.79 ,$99.01 , N/A ,$112.52 , N/A ,$98.99 , N/A , N/A ,$160.46 , N/A , N/A ,$166.33 ,$176.11 , N/A ,$146.76 ,$136.98 ,$144.80 ,$144.80 , N/A ,$166.33 , N/A , N/A ,$137.17 , N/A ,$136.98 , N/A ,$166.33 , N/A ,$54.79 ,$176.11 , N/A , N/A ,$127.19 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400297,404,PC ANESTH BREAST RADICAL/MOD RAD-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400301,520,PC ANESTH CHEST CLOSED NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400303,700,PC ANESTH ABD WALL/UPPER ANTR NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400306,750,PC ANESTH RPR HERNIA UPPER ABD NOS-QZ,964,1 ,$195.68 ,$127.19 ,$54.79 ,$195.68 ,$127.19 , N/A ,$54.79 ,$99.01 , N/A ,$112.52 , N/A ,$98.99 , N/A , N/A ,$160.46 , N/A , N/A ,$166.33 ,$176.11 , N/A ,$146.76 ,$136.98 ,$144.80 ,$144.80 , N/A ,$166.33 , N/A , N/A ,$137.17 , N/A ,$136.98 , N/A ,$166.33 , N/A ,$54.79 ,$176.11 , N/A , N/A ,$127.19 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400307,752,PC ANESTH RPR HERNIA LUMB/VENTR WND DEH-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400312,820,PC ANESTH ABD WALL LOWER POSTR-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400313,830,PC ANESTH RPR HERNIA LOW ABD NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400325,902,PC ANESTH ANORECTAL PROC-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400328,910,PC ANESTH TRANSURETHRAL PROC NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400332,920,PC ANESTH GENITALIA MALE NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400339,940,PC ANESTH VAGINAL PROCS W/BX NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400344,952,PC ANESTH HYSTEROSCOPY/HYSTERGRAPH-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400349,1320,PC ANESTH KNEE/POPLITEAL PROCS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400362,1480,PC ANESTH LWR LEG/ANKLE/FOOT OPEN NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400365,1520,PC ANESTH VEINS LOWER LEG NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400367,1620,PC ANESTH SHLDR CLOSED PROCS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400374,1810,PC ANESTH LOWR ARM NERV/MUSC/TEND PROCS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400389,31500,PC ANESTH INTUBATION ENDOTRACHEAL-QZ,964,1 ,$763.00 ,$495.95 ,$208.58 ,$763.00 ,$495.95 ,$208.58 ,$213.64 ,$386.08 ,$208.58 ,$438.73 ,$208.58 ,$386.00 ,$208.58 ,$396.30 ,$625.66 ,$521.44 ,$208.58 ,$648.55 ,$686.70 ,$208.58 ,$572.25 ,$534.10 ,$564.62 ,$564.62 ,$521.44 ,$648.55 ,$208.58 ,$208.58 ,$534.86 ,$208.58 ,$257.30 , N/A ,$648.55 ,$448.44 ,$213.64 ,$686.70 , N/A , N/A ,$495.95 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400436,732,PC ANESTH UPPER GI ERCP-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400438,811,PC ANESTH LOWER ENDO PROCS NOS-QZ,964,1 ,$88.00 ,$57.20 ,$24.64 ,$88.00 ,$57.20 , N/A ,$24.64 ,$44.53 , N/A ,$50.60 , N/A ,$44.52 , N/A , N/A ,$72.16 , N/A , N/A ,$74.80 ,$79.20 , N/A ,$66.00 ,$61.60 ,$65.12 ,$65.12 , N/A ,$74.80 , N/A , N/A ,$61.69 , N/A ,$61.60 , N/A ,$74.80 , N/A ,$24.64 ,$79.20 , N/A , N/A ,$57.20 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400489,300,PC ANESTH HEAD/NECK/TRUNK NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400490,320,PC ANESTH NECK ORGANS >1YR NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400491,400,PC ANESTH INTEG EXTRM/TRUNK NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400492,404,PC ANESTH BREAST RADICAL/MOD RAD-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400495,450,PC ANESTH CLAVICLE/SCAPULA NOS-QX,964,1 ,$195.68 ,$63.60 ,$27.40 ,$160.46 ,$63.60 , N/A ,$27.40 ,$49.51 , N/A ,$56.26 , N/A ,$49.50 , N/A , N/A ,$160.46 , N/A , N/A ,$83.17 ,$88.06 , N/A ,$73.38 ,$68.49 ,$72.40 ,$72.40 , N/A ,$83.17 , N/A , N/A ,$68.59 , N/A ,$68.49 , N/A ,$83.17 , N/A ,$27.40 ,$88.06 , N/A , N/A ,$63.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400496,520,PC ANESTH CHEST CLOSED NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400498,700,PC ANESTH ABD WALL/UPPER ANTR NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400500,750,PC ANESTH RPR HERNIA UPPER ABD NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400501,752,PC ANESTH RPR HERNIA LUMB/VENTR WND DEH-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400502,790,PC ANESTH UPPER ABD W/LAP NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400503,800,PC ANESTH ABD WALL LOW ANTR NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400504,820,PC ANESTH ABD WALL LOWER POSTR-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400505,830,PC ANESTH RPR HERNIA LOW ABD NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400506,832,PC ANESTH RPR HERNIA VENTRAL/INCISONAL-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400507,840,PC ANESTH LOWER ABD W/LAP NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400514,902,PC ANESTH ANORECTAL PROC-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400516,910,PC ANESTH TRANSURETHRAL PROC NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400519,920,PC ANESTH GENITALIA MALE NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400520,940,PC ANESTH VAGINAL PROCS W/BX NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400524,952,PC ANESTH HYSTEROSCOPY/HYSTERGRAPH-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400528,1320,PC ANESTH KNEE/POPLITEAL PROCS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400540,1480,PC ANESTH LWR LEG/ANKLE/FOOT OPEN NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400542,1610,PC ANESTH SHLDR NERV/MUSC/TEND-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400543,1620,PC ANESTH SHLDR CLOSED PROCS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400550,1810,PC ANESTH LOWR ARM NERV/MUSC/TEND PROCS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400552,1830,PC ANESTH LOWER ARM ARTHRO/ENDOSC-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400588,731,PC ANESTH UPPER GI ENDO PROC NOS-QX,964,1 ,$195.68 ,$63.60 ,$27.40 ,$160.46 ,$63.60 , N/A ,$27.40 ,$49.51 , N/A ,$56.26 , N/A ,$49.50 , N/A , N/A ,$160.46 , N/A , N/A ,$83.17 ,$88.06 , N/A ,$73.38 ,$68.49 ,$72.40 ,$72.40 , N/A ,$83.17 , N/A , N/A ,$68.59 , N/A ,$68.49 , N/A ,$83.17 , N/A ,$27.40 ,$88.06 , N/A , N/A ,$63.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400589,732,PC ANESTH UPPER GI ERCP-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400591,811,PC ANESTH LOWER ENDO PROCS NOS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),96400640,142,PC ANESTH EYE LENS-QX,964,1 ,$88.00 ,$28.60 ,$12.32 ,$72.16 ,$28.60 , N/A ,$12.32 ,$22.27 , N/A ,$25.30 , N/A ,$22.26 , N/A , N/A ,$72.16 , N/A , N/A ,$37.40 ,$39.60 , N/A ,$33.00 ,$30.80 ,$32.56 ,$32.56 , N/A ,$37.40 , N/A , N/A ,$30.85 , N/A ,$30.80 , N/A ,$37.40 , N/A ,$12.32 ,$39.60 , N/A , N/A ,$28.60 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98180529,36556,PC INS CATH CV NON-TUNL >5 YRS,981,1 ,$431.00 ,$280.15 ,$120.68 ,"$7,055.60 ",$280.15 ,"$2,822.24 ",$120.68 ,$218.09 ,"$2,822.24 ",$247.83 ,$431.00 ,$218.04 ,$431.00 ,$431.00 ,$353.42 ,"$7,055.60 ","$2,822.24 ",$366.35 ,$387.90 ,"$2,822.24 ",$323.25 ,$301.70 ,$318.94 ,$318.94 ,$431.00 ,$366.35 ,"$2,822.24 ","$2,822.24 ",$302.13 ,"$2,822.24 ",$152.11 , N/A ,$366.35 ,"$6,067.81 ",$120.68 ,$387.90 , N/A , N/A ,$280.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$51.00 ,$33.15 ,$14.28 ,$51.00 ,$33.15 , N/A ,$14.28 ,$25.81 , N/A ,$29.33 , N/A ,$25.80 , N/A , N/A ,$41.82 , N/A , N/A ,$43.35 ,$45.90 , N/A ,$38.25 ,$35.70 ,$37.74 ,$37.74 , N/A ,$43.35 , N/A , N/A ,$35.75 , N/A ,$15.74 , N/A ,$43.35 , N/A ,$14.28 ,$45.90 , N/A , N/A ,$33.15 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98500002,93016,PC CARDIAC STRESS TEST SUPERVISION,985,1 ,$106.00 ,$68.90 ,$29.68 ,$106.00 ,$68.90 , N/A ,$29.68 ,$53.64 , N/A ,$60.95 , N/A ,$53.63 , N/A , N/A ,$86.92 , N/A , N/A ,$90.10 ,$95.40 , N/A ,$79.50 ,$74.20 ,$78.44 ,$78.44 , N/A ,$90.10 , N/A , N/A ,$74.31 , N/A ,$41.22 , N/A ,$90.10 , N/A ,$29.68 ,$95.40 , N/A , N/A ,$68.90 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98500003,93018,PC CARDIOVASCULAR STRESS TEST,985,1 ,$79.00 ,$51.35 ,$22.12 ,$79.00 ,$51.35 , N/A ,$22.12 ,$39.97 , N/A ,$45.43 , N/A ,$39.97 , N/A , N/A ,$64.78 , N/A , N/A ,$67.15 ,$71.10 , N/A ,$59.25 ,$55.30 ,$58.46 ,$58.46 , N/A ,$67.15 , N/A , N/A ,$55.38 , N/A ,$27.42 , N/A ,$67.15 , N/A ,$22.12 ,$71.10 , N/A , N/A ,$51.35 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98780006,99238,PC HOSPITAL DISCHARGE DAY <31MIN,987,1 ,$218.00 ,$141.70 ,$61.04 ,$218.00 ,$141.70 , N/A ,$61.04 ,$110.31 , N/A ,$125.35 , N/A ,$110.29 , N/A , N/A ,$178.76 , N/A , N/A ,$185.30 ,$196.20 , N/A ,$163.50 ,$152.60 ,$161.32 ,$161.32 , N/A ,$185.30 , N/A , N/A ,$152.82 , N/A ,$93.29 , N/A ,$185.30 , N/A ,$61.04 ,$196.20 , N/A , N/A ,$141.70 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98800018,99232,PC SUBSQ HOSPITAL CARE LVL 2 MOD 25MIN,987,1 ,$169.00 ,$109.85 ,$47.32 ,$169.00 ,$109.85 , N/A ,$47.32 ,$85.51 , N/A ,$97.18 , N/A ,$85.50 , N/A , N/A ,$138.58 , N/A , N/A ,$143.65 ,$152.10 , N/A ,$126.75 ,$118.30 ,$125.06 ,$125.06 , N/A ,$143.65 , N/A , N/A ,$118.47 , N/A ,$92.87 , N/A ,$143.65 , N/A ,$47.32 ,$152.10 , N/A , N/A ,$109.85 
HSHS HOLY FAMILY HOSPITAL INC (ACU),98800019,99233,PC SUBSQ HOSPITAL CARE LVL 3 HIGH 35MIN,987,1 ,$313.00 ,$203.45 ,$87.64 ,$313.00 ,$203.45 , N/A ,$87.64 ,$158.38 , N/A ,$179.98 , N/A ,$158.35 , N/A , N/A ,$256.66 , N/A , N/A ,$266.05 ,$281.70 , N/A ,$234.75 ,$219.10 ,$231.62 ,$231.62 , N/A ,$266.05 , N/A , N/A ,$219.41 , N/A ,$133.84 , N/A ,$266.05 , N/A ,$87.64 ,$281.70 , N/A , N/A ,$203.45